In the study group, specimens in which sperm concentrations were too low were excluded from the study. The control group consisted of 10 males with proven fertility who had attended the Reproduction Unit to undergo vasectomy all had at least two children, one of whom was 2 ml sperm count >20×10 6 cells/ml motile sperm type Q(+++) ( WHO, 1992) >25%]. All the patients were informed of the purpose of the study and gave their consent. The patient group consisted of five males with MMD with histories of sterility diagnosed clinically and genetically. This work was designed to study firstly, the capacitation of spermatozoa and, secondly, the acrosome reaction in ejaculates of sterile males with myotonic dystrophy to see if defects in these processes can help explain the reduced fertility of MMD patients.
However, in our research of the literature we found no report in which sperm function in MMD patients had been explored. Testicular tubular atrophy in patients with severe forms of this disease is described ( Harper, 1989) but according to the World Health Organization (WHO) criteria, some patients with a history of sterility have normal seminal parameters. In addition, patients with any of the clinical forms of MMD, but especially males, are reported to have reduced fertility ( Harper, 1989). The wide range of the qualitative and quantitative variations of the clinical findings of MMD patients depends on the extent of gene mutation in the different patients (grades I, II, III, IV). Respectively these may include hypotonia of striated and smooth muscle and cardiac muscle conduction defects, ophthalmological pathologies such as cataracts and mental retardation due to endocrine deficiencies. The mutated gene expresses an abnormal muscle membrane protein kinase and consequently MMD patients present symptoms and signs of muscular, central nervous system and endocrine disorders. The mutation that causes myotonic dystrophy is the expansion of the CGT triplets at the 3′ end of the gene, that, in turn, is located on chromosome 19 (19q12) ( Buxton et al., 1992 Harley et al., 1992). Myotonic muscular dystrophy (MMD) is defined as a hereditary, autosomal dominant disease characterized by the development of structural and functional abnormalities of the muscle membrane protein myotoninkinase involved in protein phosphorylation ( Roses and Apple, 1973, 1974).
Acrosome reaction, dystrophy, d-mannose, spermatozoa Introduction
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