Objective: To study the time course of capacitation, spontaneous, and A23187-induced acrosome reaction of human spermatozoa during 8 hours incubation in vitro using the chlortetracycline (CTC) assay with a revised fluorescent pattern classification.Design: Fertile donor spermatozoa were isolated by direct swim-up and incubated in Earle's balanced salt solution for up to 8 hours. At hourly intervals, spermatozoa were stained with CTC before and after the addition of A23187 to induce the acrosome reaction.Setting: The University Clinic, Jessop Hospital for Women, Sheffield, United Kingdom. Patients: Donors participating in the Donor Insemination Program. Main Outcome Measures: Eight fluorescent patterns identified by the CTC assay and acrosome-reacted spermatozoa detected by indirect immunofluorescence using 18.6 monoclonal antibody.Results: Using a statistical model defined by analysis of deviance allowed rationalization of the CTC pattern classification by grouping together patterns that showed a similar and significant change over time. In addition, spontaneous and A23187-induced acrosome-reacted spermatozoa identified by the CTC assay were shown to be correlated significantly to those identified by indirect immunofluorescence.Conclusion: The CTC assay using a revised pattern classification offers a more precise description of human spermatozoa capacitation in vitro. Also, CTC-identified acrosome reaction (both spontaneous and A23187 induced) was confirmed independently by indirect immunofluorescence. Fertil Steril 1995;64:150-9 Key Words: Capacitation, acrosome reaction, chlortetracycline (CTC) assay, indirect immunofluorescence, human spermatozoa, A23187. InThe chlortetracycline (CTC) assay has been reported to be a suitable method to study calciumdependent events in fertilization, such as capacitation and the acrosome reaction of spermatozoa (1). Chlortetracycline binds specifically to membrane-as- Received July 27, 1994; revised and accepted February 13, 1995. * Supported by the Infertility Research Trust, University of Sheffield, Sheffield, United Kingdom. sociated calcium, resulting in a series of fluorescent patterns on the head of sperm, which show a change over time. In nonhuman studies, CTC fluorescent patterns have been classified according to the species studied, in mouse (2), and horse (3). The CTC assay provides a method by which calcium-associated membrane changes on the head of sperm, which occur during the capacitation process, can be observed directly. Hence, the CTC assay provides an area of great interest in reproductive biology. Lee and co-workers (4) first described a classification for CTC patterns in human sperm and were able to quantify the changes in patterns during time course studies. The classification consists off our major patterns: early fresh (EF) for un capacitated sperm, shown by a bright band of fluorescence in
The World Health Organization (WHO, 1992) has suggested new criteria for scoring sperm morphology. This study compares the clinical value of the new criteria, i.e. classification of a man as fertile or infertile, to those previously established by the WHO (1987). Papanicolaou-stained semen smears from 166 men attending our infertility clinic, whose fertility status was known, were scored using both methods. Using logistic discriminant analysis for compositional data, no difference between these two sets of criteria with respect to predicting pregnancy outcome was observed. The categorization of the abnormalities (head, midpiece, tail) provides no extra clarification. The WHO (1992) cut-off point of 30% for normal forms is not appropriate, as approximately half of the men in the fertile group had a normal sperm morphology below this limit. In conclusion, the present WHO (1992) classification of sperm morphology is of no additional clinical value. Studies on sperm morphology should concentrate on obtaining biological data on, and measurements of, spermatozoa which are functionally active. Only then can the definition of normal be achieved and clinically useful criteria be adopted.
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