The seminal plasma of subfertile men is a recognised site for the presence of microorganisms (Cottell et al., 2000); however, the infiltration and activation of leukocytes in response to colonisation of the MGT can result in negative impact on the male carrier’s fertility status (Comhaire et al., 1999). With the research that has focused on the incidence of seminal microflora, the implementation of a routine semen culture of samples undergoing a spermiogram for fertility assessment has been encouraged (Korrovits et al., 2006). It has been suggested that prior to undergoing ART, patients who have presented with ejaculates that are identified positive for bacteria, routinely receive antibiotic treatment to treat infection (Fourie et al. 2011). Based on this study’s findings regarding the occurrence rate of STIs amongst the men seeking fertility assessment at TBH, future laboratory based applications could be included to combat the occurrence of particular micoorganisms in semen samples. A study conducted at Steve Biko Academic Hospital, Pretoria, South Africa, demonstrated the efficacy of utilising a polypropylene centrifuge insert during semen sample washing. The results showed that employing the particular insert, whilst aspirating the sperm pellet formed during double-density gradient centrifugation, resulted in 96% more bacteria being removed from the semen sample in comparison to the conventional approach (Fourie et al., 2011). The successful elimination of bacteria species which is economically accommodating could be valuable in a South African Government Hospital offering fertility assistance, such as TBH.
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5.2 Objective 2:
Examine the effects of N. gonorrhoea, C. trachomatis and T. vaginalis, in comparison to the control group, on the standard semen parameters which includes; pH, volume, leukocyte count, viscosity and polymorphonunclear elastase concentration, and the spermatozoa parameters including; motility, concentration, morphology, viability and acrosome reaction.
The analysis of a semen sample is generally considered to be the primary laboratory assessment method to identify the fertility status of the male partner (Rodríguez-Martínez H, 2007). There are a variety of contributory factors that may be responsible for compromised sperm parameters, such as: abnormal spermatogenesis, environmental and lifestyle factors, as well as post-testicular damage in the epididymis (WHO, 2010). Possible deviations of spermatozoa parameters from the standardised WHO values, such as the concentration, viability, morphology and acrosome intactness, can help to identify a possible underlying pathological condition. Results from the analyses of the parameters included in this study have demonstrated the negative effect of the presence of an STI on the spermatozoa’s functional capacity. This is to be elobaroted further in the discussion below.
5.2.1 pH
Secretions from the accessory sex glands interact to dictate the pH level of semen. Semen is multi- glandular in origin with the acidic prostatic and alkaline seminal vesicle secretions combining to produce an alkaline fluid with a high pH ranging from approximately 7.2 to 8.0. This neutralising effect is important as sperm function more advantageously in an alkaline environment and require a buffer from the hostile environment of the female reproductive tract, which can present with cervical mucus and vaginal secretions which are acidic fluids (WHO, 1992).
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Results of this study found no significant difference in the pH values between the three STI postive groups and the control. The pH values differed only slighty, with the most alkaline being the control group with a mean pH of 7.60 ± 0.04, whereas the samples positive for the bacterium N. gonorrhoea was slightly higher at 7.76 ± 0.09 (Figure 15; Table 2).
As the pH of the semen is a reflection of the ASGs secretions, abnormal pH levels in a semen analysis can signify glandular dysfunction (Weidner et al., 1999). The assesment of the levels of citric acid and fructose in the seminal plasma, can be indicative of the functioning of the prostate and seminal vesicles respectively. The quantification of the citric acid (mg/ejaculate) found the samples positive for N. gonorrhoea, C. trachomatis and T. vaginalis to fall above the WHO reference level of 9.36 mg/ejaculate, therefore, indicating normal prostate function. N. gonorrhoea was the only sample group that fell below the reference value of 2.34 mg/ejaculate of fructose, a marker of seminal vesicle function, with a mean of 1.79 ± 0.26 mg/ejaculate. It can be stated that although infection was detected in the ejaculates postive for C. trachomatis and T. vaginalis, ASG functioning of the prostate and therefore, the pH was not a parameter that was compromised.
5.2.2 Volume
Upon assesment of the volume of the ejaculate, it was found that none of the four groups had a mean volume below the WHO reference value of 1.5 ml. This is in accordance with the findings of a study by Bezold et al., which examined the relationship between STIs and semen variables (Bezold et al., 2007). Results of this study demonstrated that the N. gonorrhoea positive population had the lowest semen volume of 2.49 ± 0.64 ml (Figure 13; Table 2) however, there was no statistically significant difference in the mean volume between N. gonorrhoea, C. trachomatis, T. vaginalis and the control group. One factor contributing to this finding could be the results of objective 4, which focused on the secretory function of the ASGs, in particular the seminal vesicles and the prostate. The latter is a a 4- lobe gland which contributes between 15-30 % to the ejaculates volume (Nieschlag and Behre, 2000),
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with a WHO-defined reference value of 9.36 mg of citric acid per ejaculate. The prostate is the ASG that is primarily affected by infection of the MGT (Wolff et al., 1991). However in this study, the spectrophotometric quantification of the levels of mean citric acid per ejaculate amongst the sample groups positive for N. gonorrhoea, C. trachomatis and T. vaginalis all fell above the WHO reference value, thus indicating that the secretory function was not compromised. Although infection and inflammation may affect the volume of the ejaculate, this was not observed in this study and no significant differences were observed.