Chlamydia trachomatis infection in the genital tract is associated with inflammation and hypospermia in the infertile male of China
Main article: Increase your sperm count
Chlamydia trachomatis (CT), also known as chlamydia, is the most common bacterium responsible for sexually transmitted infections. In females chlamydia infection affects female fertility without a doubt however this is less certain for males.
Previous studies claimed that chlamydia infection in males impairs sperm quality while other studies showed that chlamydia did not directly affect sperm quality, but instead caused inflammation, resulting in obstruction of the ejaculatory duct and the production of antisperm antibodies.
Conversely some studies also showed that chlamydia has no effect on sperm quality or male fertility adding to the debate among researchers on whether or not CT has a real effect on male fertility.
To evaluate the impact of CT infection in the genital tract on sperm quality, sperm acrosin activity, antisperm antibody levels and inflammation in a large cohort of infertile men.
Males seeking infertility treatment at the Reproductive Center of The Third Affiliated Hospital (Guangzhou Medical University) provided semen samples for analysis following 2 to 7 days of abstinence.
Male infertility was defined as the inability of a woman to conceive after 12 months of regular sexual activity, with no contraception, in the absence of any known female factors.
Female partners were therefore evaluated for infertility with any findings automatically excluding their male partner from this study while men not from mainland China, on antibiotics, missing data, incorrect sample container or samples not sent for assessment within 30 mins were also excluded from the study.
Manual and computer-aided sperm analysis was carried out according to the World Health Organization (WHO) Laboratory Manual for the Examination and Processing of Human Semen (5th edition).
Seminal plasma granulocyte elastase levels for bacterial infection, and sperm acrosin activity was determined using specific quantitative assay kits, while levels of antisperm antibodies was evaluated by mixed antiglobulin reaction testing.
The presence of CT was confirmed using a real-time quantitative polymerase chain reaction Nucleic Acid detection kit.
A total of 7154 infertile male semen samples satisfied the inclusion exclusion criteria.
Following the detection of CT, 416 CT positive men formed the CT+ group and 6738 men the CT- group for further analysis. Mean age for each group was 33.5 years (CT+) and 34.5 years (CT-).
Initial analysis showed that the proportion of males with normal semen volume (≥ 1.5ml) was statistically higher among the CT- group (91.5% vs. 87.5%) while the proportion of males with normal sperm viability (≥ 58%) was statistically higher among the CT+ group (94.0% vs. 90.3%).
Similarly, the proportion of males with normal progressive sperm motility (≥ 32%) and total sperm motility (≥ 40%) was also statistically higher in the CT+ group (83.7% vs. 78.4% and 79.1% vs. 74.5% respectively).
Significantly the proportion of makes with normal white blood cell count was lower in the CT+ group (88.2% vs. 97.5%) with no other differences found in either sperm concentration, sperm motility parameters or normal forms.
Further analysis of 9 unique sperm morphological parameters identified a statistical difference in the sperm midpiece deformity rate, with the CT+ group showing a lower deformity rate (15.2% vs. 15.8%).
Not surprisingly seminal plasma granulocyte elastase levels found that the latent infection rate and confirmed infection rate was significantly higher in the CT+ group (32.0% vs. 24.8% and 38.0% vs. 22.1%) compared to the CT- group which was consistent with the increase in white blood cell counts indicating inflammation.
On the other hand antisperm antibody tests found no differences in the proportion of negative, weakly positive or positive males between the 2 groups, with a similar finding for acrosin activity indicating that CT infection has no effect on the levels of antisperm antibody in males or sperm acrosin activity required for penetration of the embryo.
SUMMARY: DOES CHLAMYDIA CAUSE INFERTILITY IN MALES
In this large study, infertile males positive for chlamydia infection were more likely to have abnormal semen volume and white blood cell counts, indicating inflammation associated obstruction of the ejaculatory duct, which can lead to abnormal sperm count, also known as oligospermia.
- Sperm DNA fragmentation was not evaluated.
This study was supported by grants from the Guangzhou City Science Technology and Innovation Commission, National Natural Science Foundation of China, Guangdong Basic and Applied Basic Research Foundation, Guangdong Province Outstanding Youth Medical Talent Program, Liwan District Science and Technology Planning Project and The Third Affiliated Hospital of Guangzhou Medical University Elite Talent Fund Project.
Major proteinase present in the acrosome of mature sperm.
Dormant inactive infection.
Also known as semen, organic fluid containing sperm.
Baud D, et al. (2019). Sperm microbiota and its impact on semen parameters. https://doi.org/10.3389/fmicb.2019.00234
Puerta Suarez J, et al. (2017). Chlamydia trachomatis neither exerts deleterious effects on spermatozoa nor impairs male fertility. https://doi.org/10.1038/s41598-017-12316-4
Liu J, et al. (2014). Prevalence of Ureaplasma urealyticum, Mycoplasma hominis, Chlamydia trachomatis infections, and semen quality in infertile and fertile men in China. https://doi.org/10.1016/j.urology.2013.11.009
Sellami H, et al. (2014). Molecular detection of Chlamydia trachomatis and other sexually transmitted bacteria in semen of male partners of infertile couples in Tunisia: the effect on semen parameters and spermatozoa apoptosis markers. https://doi.org/10.1371/journal.pone.0098903
Osazuwa F, et al. (2013). The prevalence of Chlamydia trachomatis infection among infertile males and its association with abnormal semen characteristics in Delta State, Nigeria. https://doi.org/10.4314/thrb.v15i2.3
l-Sweih N A, et al. (2012). Prevalence of Chlamydia trachomatis, Mycoplasma hominis, Mycoplasma genitalium, and Ureaplasma urealyticum infections and seminal quality in infertile and fertile men in Kuwait. https://doi.org/10.2164/jandrol.111.013821
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