The impact of chronic prostatitis (cP) on male fertility has attracted widespread attention in recent years. cP generally does not directly affect the spermatogenesis in the testes and the sperm maturation process in the epididymis of patients. The actual fact is that the prostate gland is a very important accessory gland organ and its secretion, prostatic fluid, is the main component of semen and is directly related to the quality of semen and the vitality of sperm.
1 .Alteration of semen properties
1.1 Alteration of acidity
The pH of semen is mainly the result of mixing prostatic fluid and seminal vesicle fluid, the ratio is about 1:2. Normal semen is weakly alkaline, ph7.2-7.8, sperm survive well and move freely under such acidity. With CP, the acidity in the seminal plasma increases, causing the pH to decrease. When the pH decreases to the minimum requirement for sperm survival (pH < 6.0), the sperm loses its vitality. pH > 8.2 increases sperm vitality instead, but if the pH is greater than 9.0, the vitality decreases again…. CP has a great effect on the secretion of prostatic fluid and its pH, which can cause the pH increases.
1.2 Increased viscosity and abnormal liquefaction
Fresh semen quickly appears as a solidified jelly-like with a certain viscosity when it is first ejected from the body, and gradually liquefies into a thin watery liquid after 2-20rain. The activity of enzymes in the prostatic fluid decreases and the coagulation factor increases relatively when you have CP, which makes the semen not easy to liquefy and the viscosity of semen increases significantly, which is not conducive to the normal activity of sperm and makes the fertility decrease.
1.3 Altered secretion function and reduced nutrients
In CP patients, due to the presence of infectious factors, bacteria, inflammatory cells and lactic acid in seminal plasma will also increase. Bacteria and inflammatory cells can absorb a large amount of oxygen and nutrients from seminal plasma, especially macrophages can phagocytose a large amount of lipids, so that the lecithin vesicles in prostatic fluid will be reduced, thus making the survival of sperm affected. Inflammation of the prostate can cause changes in the composition of seminal plasma, resulting in a deficiency of calcium, magnesium, zinc, citrate, lipids, proteins and other components that are conducive to maintaining the stability of the normal internal environment of sperm, thus reducing male fertility. Non-infectious factors of CP, due to long-term congestion, swelling and atrophy of the glandular ducts and weakened secretion function, can also affect the normal physiological function of sperm, resulting in reduced fertility.
1.4 Influence the osmotic pressure of semen
The osmotic pressure of semen has an important physiological significance in maintaining the normal vitality of spermatozoa. When the osmotic pressure is low, the vitality of spermatozoa increases, when it is high, the vitality decreases, and when it is too high, the spermatozoa have a deformed coiled tail. Spermatozoa in the hypertonic environment of the epididymis have extremely low viability due to dehydration, slow metabolism and long survival time. Once ejaculated, they immediately enter the seminal plasma with lower osmotic pressure and are activated and have a shorter survival time. In case of CP, semen viscosity increases, osmotic pressure rises, sperm viability decreases and fertility is affected.
1.5 Abnormal sperm quality
The amount of ejaculate in healthy men is 2-6ml each time, and the secretion of seminal plasma is mostly reduced in CP, which is not conducive to the survival and activity of sperm. It has been found that the abnormal secretion function of the prostate gland in CP is related to the enhanced apoptotic effect of sperm; the amount of seminal plasma is sometimes increased, which reduces the amount of sperm, and sperm dilution also affects fertility.
1.6 Hemospermia
A large amount of blood component found in semen is hematospermia. Severe hematospermia can reduce sperm vitality and affect fertility. The main cause of hematospermia is infection of the reproductive tract and accessory gonads, and CP can also appear as hematospermia.
2, the effect of white blood cells on semen quality
2.1 Origin of self-cells in semen
There is controversy regarding the origin of leukocytes in semen. The source of leukocytes is difficult to identify because of the lack of characteristic clinical symptoms in patients with reproductive tract infections and infertility. Leukocyte count in semen is <1.0×106/ml under normal conditions, and leukocytospermia is considered when it is >1.0×106/ml. It is usually believed that the testes, epididymis, and prostate may be the main source of self-cells in semen, independent of the seminal vesicles, because there are fewer leukocytes in the semen of vasectomized individuals. In addition, the lower citric acid levels in leukocytic spermatozoa suggest that asymptomatic prostatitis may be the source of leukocytes. Leukocytospermia can affect sperm morphology and viability, but not accessory gonad function. However, infection is not the only cause of increased autocytosis in semen, as leukocyte chemotactic activity is also present in semen of patients with varicocele.
2.2 Effect of proteases on semen quality
Granulocytes contain a large number of proteases, including peroxidase, elastase, collagenase, etc. Under normal conditions, these enzymes exist in an inactive form in the presence of protease inhibitory factor and a 2 a macroglobulin. If the proteases are once in excess or in the absence of a 2 a macroglobulin and protease inhibitory factor, granulocytes can cause severe cellular damage. When leukocytes are activated and proliferate in the reproductive tract, the secretion also increases, and proteases can damage sperm while killing bacteria.
2.3 Effect of cytokines on semen quality
The effect of cytokines on semen quality has been reported inconsistently. It has been reported that activated lymphocytes and phagocytes can release lymphatic activator and monocyte activator, which have significant effects on sperm viability.
2.4 Effect of oxygen free radicals on semen quality
Oxygen is necessary for the survival of aerobic cells, but its metabolite oxygen radicals (ROS) can impair cell function or/and disrupt the internal environment of cells, and ROS must be constantly inactivated to maintain normal cell function, and sperm cells are no exception MJ. Leukocytes are probably the main source of oxygen radicals (ROS) in semen, and under normal conditions, due to the presence of leukocytes and spermatozoa, semen contains low concentrations of ROS, and based on the different nature and density of ROS, ROS can play both positive and negative roles, and there is also a balance of ROS oxidation and antioxidant capacity. When leukocytes phagocytose foreign substances, they can produce a series of ROS. Excess ROS can affect human sperm function and reduce sperm motility by inducing peroxidative damage to unsaturated fatty acids in the sperm plasma membrane.
ROS mainly include superoxide anion (O: a), hydrogen peroxide (H: 0:) and hydroxyl radical (OH a) M J3. The “respiratory burst” is the main source of the above ROS, which occurs in neutrophil-sensitized monocytes, macrophages and eosinophils, when they are subjected to the action of bacteria and other stimuli, a series of rapid biochemical reactions will occur, generating a large number of 0: a, H: O: a, OH, etc. reactive oxygen components, which The mechanism of ROS-induced sperm cell damage is mainly by attacking the sperm cell membrane and causing lipid peroxidation of the cell membrane. Leukocytes are probably the main source of ROS in semen.
2.5 Direct phagocytosis
Phagocytes may phagocytose spermatozoa directly or through the conditioning effect of antibodies, resulting in a decrease in sperm count and viability.
2.6 Pus spermatozoa
Pus cells found in semen with white blood cell count >l×106/ml and with infertility is spermatozoospermia. In spermatozoa pus, in addition to the increase in leukocytes leading to various damages to sperm, it can also increase the viscosity of semen and reduce the viability of sperm and affect fertility.