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- Original Article -
Sperm nuclear histone H2B: correlation with sperm DNA denaturation and DNA stainability
Armand Zini, Xiaoyang Zhang, Maria San Gabriel
Division of Urology, Department of Surgery, Royal Victoria Hospital, McGill University, Montreal, Quebec H3T 1M5,
Canada
Abstract
Aim: To examine the relationship between sperm DNA damage and sperm nuclear histone (H2B)
staining. Methods: We evaluated sperm samples from 14 consecutive asthenoteratozoospermic infertile men and six consecutive fertile
controls. Sperm nuclear histone (H2B) staining and sperm chromatin integrity (assessed by sperm chromatin structure
assay and expressed using the percentage of (i) DNA fragmentation index [%DFI] and (ii) high DNA stainability
[%HDS)]) were evaluated. Results: Histone H2B immunocytochemistry demonstrated two nuclear staining patterns:
(i) focal punctate staining; and (ii) diffuse staining. Infertile men had a higher mean percentage of spermatozoa
exhibiting diffuse H2B staining than did fertile men (7.7% ± 4.6%
vs. 1.6% ± 1.2%, respectively,
P < 0.01). We observed significant relationships between the proportion of spermatozoa with diffuse nuclear histone staining and
both sperm %DFI (r = 0.63,
P < 0.01) and sperm %HDS
(r = 0.63,
P < 0.01). Conclusion:
The data demonstrate that infertile men have a higher proportion of spermatozoa with diffuse histone H2B than do fertile men and suggest
that sperm DNA damage might, at least in part, be due to abnormally high histone H2B levels.
(Asian J Androl 2008 Nov; 10: 865_871)
Keywords: spermatozoa; sperm DNA; histones; male infertility; DNA fragmentation
Correspondence to: Dr Armand Zini, St. Mary's Hospital, 3830 Lacombe Avenue, Montreal, Quebec H3T 1M5, Canada.
Tel: +1-514 345-3511 Fax: +1-514-734-2718
E-mail: ziniarmand@yahoo.com
Received 2007-12-01 Accepted 2008-03-28
DOI: 10.1111/j.1745-7262.2008.00415.x
1 Introduction
Sperm chromatin is very tightly compacted as a result of the associations between the DNA and the sperm nuclear
proteins [1, 2]. During the later stages of spermatogenesis (spermiogenesis), spermatid nuclear remodeling and
condensation is associated with histone modifications and the sequential displacement of histones by transition
proteins and then by protamines [1].
In humans, up to 15% of the sperm DNA remains packaged by histones in sequence-specific areas [3, 4]. Several
histone isoforms (H2A, H2B, H3 and H4) and isoform variants are present in human spermatozoa, with the
predominant isoform being histone H2B [5]. Recently, two distinct human testis/sperm-specific H2B variants (hTSH2B and
H2BFWT) were cloned and characterized [6, 7]. There is evidence to show that these isoform variants might not be
uniformly expressed in human spermatozoa, suggesting the presence of
different sperm populations in the human ejaculate [6, 8]. Although the exact role of histone H2B variants is unknown, the accumulation of H2B variants during
spermatogenesis and the association of H2B with telomeres suggest a potential involvement in spermiogenesis and
fertilization [7, 9].
Sperm protamine deficiency (partial or complete) is
demonstrated in some infertile men [10_13]. Studies
suggest that sperm protamine deficiency (or histone
retention) is related to sperm DNA damage [14]. As such,
we sought to further examine the relationship, if any,
between sperm DNA damage and sperm nuclear protein
content by examination of sperm chromatin structure
(DNA denaturation and DNA stainability) and sperm
nuclear somatic histone H2B (more accurately designated
as HIST2H2BE [15]) immunostaining in samples from fertile and infertile men. We have focused our studies on
H2B as this is the predominant histone isoform in human
spermatozoa [5] and we have previously observed that
the ratio of H2B to protamine is increased in the
spermatozoa of infertile men [13]. However, we cannot
exclude the possibility that the levels of other histone
species are increased (or decreased) in spermatozoa of
infertile men and that these alterations might be associated
with chromatin packaging defects.
2 Materials and methods
2.1 Materials
Acridine orange (AO) was purchased from PolySciences (Warrington, PA, USA). Unless specified,
all the chemicals in the present study are from Fisher
Chemical (Elvet Scientific, Bearpark, Canada).
2.2 Study subjects and semen handling
Semen samples were obtained from consecutive asthenoteratozoospermic men (with < 50% sperm
motility, < 15% normal forms and normal sperm
concentration [> 20 × 106 sperm/mL]) presenting for
infertility evaluation (n = 14). All couples presenting for
infertility evaluation had primary infertility (no prior
pregnancy) and had been unable to conceive naturally
for at least one year. The infertile men were selected
based on the observation that abnormalities in sperm
motility and morphology have been associated with an
aberrant histone to protamine ratio in mice with a
targeted disruption of the protamine gene [16]. Couples
with significant female-factor infertility (tubal
obstruction or ovarian failure) were excluded.
Semen samples (n = 6) were also obtained from
consecutive fertile controls (men presenting for vasectomy
who had previously fathered at least two children with
one born in the past 5 years).
Samples were produced by masturbation after 3_5
days of sexual abstinence and allowed to liquefy at room
temperature. After liquefaction of semen, standard
semen parameters (volume, concentration, motility and
morphology) were obtained according to World Health
Organization (WHO) guidelines [17]. A small aliquot of
semen (approximately 25_100 mL, containing
approximately 2 × 106 spermatozoa) was frozen at
_70oC for later evaluation of sperm DNA damage. All of the semen
samples had motile sperm and none had significant
numbers of round cells or leukocytospermia, as per World
Health Organization guidelines (< 1 000 000 round cells
per mL).
All patients signed an informed consent and the
information for this study remained confidential and within
the institution. This study was approved by the ethics
review board at McGill University (Montreal, Canada).
2.3 Immunocytochemistry
Semen was washed with phosphate-buffered saline
(PBS, pH = 7.4) and smears were prepared on Fisher
Superfrost Plus slides (Elvet Scientific). The smears
were fixed in 100% methanol for 2 h, air-dried and then
stored at _70ºC. Prior to immunostaining, smears were
brought to room temperature, re-hydrated with PBS for
30 min and decondensed in 5 mmol/L DTT and
0.3 μg/mL heparin for 30_60 min (to ensure full decondensation of
> 90% of the spermatozoa) at room temperature
(22_24ºC).
Immunostaining for H2B was performed using a human-specific rabbit anti-H2B (Upstate, Charlottsville, VA,
USA). We and others have demonstrated the specificity
of the H2B antibody by Western blot analysis [13, 18].
Briefly, smears were blocked with 5% goat serum in
PBS for 30 min, washed with PBS containing 0.1%
Triton X-100 (PBS-T), and incubated with the H2B
antibody (dilution 1:300) for 1 h at 20ºC. Smears were then
washed with PBS-T and incubated with
Flurochrome-conjugated goat anti-rabbit antibody (Invitrogen,
Carlsbad, CA, USA). After that, smears were mounted
with Prolong Antifade and observed under a Carl Zeiss
Axiophot microscope (exciter filter BP450-490,
emission filter BP520) at × 1 000 magnification. All
immunostaining experiments were carried out on the same
run and the data were recorded by two separate and
blinded observers (inter-observer variability was 7.7%).
At least 200 spermatozoa were assessed per slide. The
mean percentage (± SD) of sperm exhibiting (i) diffuse;
and (ii) focal punctate staining was recorded. Negative
controls were performed in the absence of primary antibody.
2.4 Sperm DNA fragmentation index (DFI) and high DNA
stainability (HDS)
Sperm DNA damage was assessed using the sperm chromatin structure assay and the results were expressed
as the percentage of spermatozoa with DNA denaturation
(also known as %DFI and %HDS), as previously
described [19_21]. Stored semen samples were thawed
on ice and 200 μL of TNE (0.01 mol/L Tris-HCl,
0.15 mol/L NaCl and 1 mmol/L EDTA, pH 7.4) was added
to the sample. The samples were treated for 30 s with
400 μL of a solution of 0.1% Triton X-100, 0.15 mol/L
NaCl and 0.08 mol/L HCl, pH 1.2. After 30 s, 1.2 mL of
staining buffer (6 μg/mL AO, 37 mmol/L citric acid,
126 mmol/L Na2HPO4, 1 mmol/L disodium EDTA,
0.15 mol/L NaCl, pH 6.0) was admixed to the test tube and
3 min later the sample was analyzed by flow
cytometry.
Following excitation by a 488-nm wavelength light
source, AO bound to double-stranded DNA emits green
florescence (515_530 nm) and AO bound to
single-stranded DNA emits red florescence (¡Ý 630 nm). The
sample is stained with AO, placed into the FACS Calibur
flow cytometer (Becton Dickinson, San Jose, CA, USA)
with the sample flowing to establish excellent
sheath/sample flow, and then 3 min after AO staining
measurements are taken. A minimum of 5 000 cells from two
aliquots of each sample were analyzed by FACS scan
interfaced with a data handler (CELLQUEST 3.1, Becton
Dickinson) on a Power Macintosh 7600/132 computer (Cupertino, CA, USA). WinList (Verity Softwarehouse,
Topsham, ME, USA) was used to generate the cytogram
(red vs. green fluorescence) and histogram (total cells
vs. DFI) plots, as well as, %DFI and %HDS readings. A
mean of the two sperm %DFI and %HDS values was reported.
Fresh and frozen-thawed samples have yielded
similar results (< 5% variability) [21]. We have shown that
the inter-assay variability of sperm %DFI is low (< 5%)
by repeat assessments of reference semen samples [21].
Over 300 aliquots of the same semen sample (reference
sample) have been stored at _70ºC for ongoing
assessment of inter-assay variability. A reference sample is used
to set the red and green photomultiplier tube (PMT)
voltage gains to give the same means for red and green
florescence levels (130/1 000 and 500/1 000 channels + 5).
A new reference sample is run every 6_10 samples to
avoid drift. We have previously validated our assay by
assessing sperm DNA fragmentation in parallel with
sperm %DFI and have shown a strong association between these two measures of DNA damage [22].
2.5 Data analysis
Results were expressed as mean ± SD. Inter-group
(fertile and infertile men) differences in sperm
parameters were assessed by Mann-Whitney rank sum test.
The relationships between parameters were examined
using linear regression techniques with Pearson's
correlation coefficient. All hypothesis testing was two-sided,
with P < 0.05 deemed as significant. Statistical analysis
was performed using Sigma Stat software (SPSS, Chicago, IL, USA).
3 Results
3.1 Sperm parameters, %DFI and %HDS
The mean (± SD) sperm concentration, motility,
%DFI and %HDS in samples from fertile and infertile
men are shown in Table 1. As expected, sperm
concentration and motility were significantly higher in samples
from fertile compared to infertile men
(P < 0.05). Mean sperm %DFI was significantly higher in samples from
infertile compared to fertile men.
3.2 Histone H2B immunostaining
Immunocytochemistry experiments using histone H2B antibody demonstrated one of two sperm nuclear
staining patterns: (i) focal, punctate staining (Figure 1A)
and (ii) diffuse staining (Figure 1B). Negative controls
(absence of primary antibody) demonstrated no
detectable sperm nuclear staining (data not shown). Infertile
men had significantly higher proportions of spermatozoa
exhibiting diffuse nuclear staining patterns than did
fertile men (Table 1).
3.3 Relationship between histone H2B immunostaining
and sperm motility, %DFI and %HDS
We observed significant inverse relationships between
the proportion of spermatozoa with diffuse nuclear histone
(H2B) staining and both percentage sperm motility
(r = _0.45, P < 0.05) and sperm concentration
(r = _0.54, P < 0.05).
We also observed significant relationships between the
proportion of spermatozoa with diffuse nuclear histone (H2B)
staining and both sperm %DFI (r = 0.63,
P < 0.01; Figure 2) and sperm %HDS
(r = 0.63, P < 0.01; Figure
3).
4 Discussion
We have found that semen samples from asthenoteratozoospermic infertile men possess a higher
percentage of spermatozoa with diffuse sperm nuclear histone
H2B staining than sperm from fertile men and that the
diffuse nuclear histone H2B staining is inversely related
to both sperm motility and sperm concentration. We
have previously reported that spermatozoa with diffuse
nuclear histone H2B staining have a relative reduction in
protamine staining, suggesting that these spermatozoa
have an increased histone to protamine ratio [13]. We
recognize that the immunocytochemistry data are
semi-quantitative and, therefore, have specifically recorded the
pattern of nuclear staining (diffuse vs. punctate)
reflecting different sperm subpopulations, rather than the
intensity of staining. Taken together, the data suggest that
a diffuse nuclear H2B staining pattern is abnormal and
are in keeping with reports indicating that histone
retention is common in infertile men [10_13].
Our data suggest that infertile men with a high
percentage of spermatozoa with diffuse nuclear histone H2B
have defective spermiogenesis as this is the specific step
in spermatogenesis where the final assembly of sperm
proteins occurs. Moreover, the finding of two sperm
subpopulations suggests that spermiogenesis is also
heterogeneous within the testicle (it is during spermiogenesis
that sperm nuclear compaction and the exchange of
histones to protamines takes place). The focal, punctuate
staining observed in the majority of spermatozoa
suggests that H2B is principally located at the periphery of
the sperm nucleus, as previously demonstrated [7, 9].
Although there is sequence homology between somatic H2B and TSH2B (approximately 95% sequence
homology at the C-terminal region [6]) and, to a lesser
extent, between somatic H2B and H2BFWT (70% sequence homology at the C-terminal region [7]) that might
cause our monoclonal somatic H2B antibody (targeting
the C-terminal) to cross-react with other H2B variants,
there is good evidence to show that the antibody we have
used is specific to somatic H2B. First, Tovich and Oko
[18] have used the same antibody and have demonstrated
its specificity to somatic H2B. Second, there is good
evidence that H2B variants (particularly, TSH2B and
somatic H2B) do not co-migrate on acid-urea (AU) gels [5,
6, 23] and we have repeatedly demonstrated a single band
on the western immunoblots (from AU gels) with this
antibody [13]. Finally, we have further verified the
specificity of the antibody by extended separation of nuclear
histones on AU gels and again have observed a single
band on the western immunoblots [13].
Our results demonstrate that the proportion of
spermatozoa with diffuse H2B staining (suggestive of H2B
retention) is associated with sperm DNA damage. Other
investigators have similarly shown that abnormal sperm
nuclear protein composition is associated with sperm
DNA damage. Cho et al. [16] and Tanaka
et al. [24]observe that sperm from protamine-deficient mice
exhibit reduced chromatin stability (the nuclei possess a
lower resistance to chemical disruption when compared
to that of wild-type mice), which likely explains the
greater susceptibility of protamine-deficient human
spermatozoa to DNA fragmentation. Aoki
et al. [14] demonstrate an inverse relationship between total protamine
concentration and DNA fragmentation. Moreover, the same
investigators show that spermatozoa with diminished
protamine content are more likely to possess DNA
damage [25]. Increased sperm DNA damage has also been
demonstrated in mice with targeted disruption of the
protamine gene and in humans with a single nucleotide
polymorphism in the protamine gene [16, 26]. Our data
further support the concept that sperm DNA damage might in part be a result of a relative increase in the
histone to protamine ratio. The data also suggest that at
least some of the DNA damage that is detected in
ejaculated spermatozoa originates in the testis, during
spermiogenesis (where and when protamines are
incorporated into the sperm nucleus).
Our data indicate that increased levels of sperm
nuclear histone H2B are associated with an increased
proportion of spermatozoa with high DNA stainability.
The high DNA stainability is a result of increased
accessibility of dyes to the sperm DNA and suggests that
increased levels of nuclear H2B might lead to a "looser" or
"more porous" sperm chromatin [20, 27]. Indeed,
Evenson et al. [27] demonstrate that the stainability of
histone-complexed DNA in round spermatids (stained
with acridine orange after low pH extraction of H1
histones) is fivefold higher than the protamine-complexed
DNA in mature spermatozoa. In a case study of a man
with a febrile illness, Evenson et al. [20] demonstrate
that the temporal changes in sperm DNA stainability were
linked to changes in the histone to protamine ratio.
Singleton et al. [28] similarly find that testis-specific H2B
levels in human spermatozoa are inversely correlated to
chromatin compaction, suggesting that a relative reduction in
nuclear protamine levels results in poor sperm nuclear
compaction. Our data further support the concept that
poor sperm chromatin compaction might also in part be
due to a relative increase in the histone to protamine ratio
[16, 26].
Sperm DNA damage and chromatin abnormalities are
clinically relevant as they have been associated with
reduced fertility potential [29, 30]. Couples in whom the
husband has a high percentage of spermatozoa with DNA
damage have very low potential for natural fertility and a
prolonged process of achieving pregnancy [19, 31, 32].
High levels of sperm DNA damage have also been
associated with poor pregnancy outcomes after intra-uterine
insemination and conventional in vitro fertilization [33,
34]. However, the impact of sperm DNA damage on reproductive outcomes after intracytoplasmic sperm
injection is less clear [34_36]. Finally, couples with
pregnancy resulting in miscarriage demonstrate a trend
toward poorer sperm DNA integrity, as compared to that
of highly fertile couples [19, 37].
In summary, we have shown that infertile men
possess a higher percentage of spermatozoa with increased
levels of sperm nuclear histone H2B staining than do
fertile men. We have also found that the increased levels of
sperm nuclear histone H2B is associated with poor sperm
motility and chromatin compaction and with increased
sperm DNA damage. Taken together, the data support
the concept that poor sperm chromatin compaction and
DNA damage in humans might, in part, be a result of an
underlying defect in the sperm histone to protamine ratio.
References
1 Balhorn R. A model for the structure of chromatin in human
sperm. J Cell Biol 1982; 93: 298_305.
2 Balhorn R, Brewer L, Corzett M. DNA condensation by
protamine and arginine-rich peptides: Analysis of toroid
stability using single DNA molecules. Mol Reprod Dev 2000;
56: 230_4.
3 Gatewood JM, Cook GR, Balhorn R, Bradbury EM, Schmid
CW. Sequence-specific packaging of DNA in human sperm
chromatin. Science 1987, 236: 962_4.
4 Wykes SM, Krawetz SA. The structural organization of sperm
chromatin. J Biol Chem 2003; 278: 29471_7.
5 Gatewood JM, Cook GR, Balhorn R, Schmid CW, Bradbury
EM. Isolation of four core histones from human sperm
chromatin representing a minor subset of somatic histones. J
Biol Chem 1990; 265: 20662_6.
6 Zalensky AO, Siino JS, Gineitis AA, Zalenskaya IA, Tomilin
NV, Yau P, et al. Human testis/sperm-specific histone H2B
(hTSH2B). Molecular cloning and characterization. J Biol
Chem 2002; 277: 43474_80.
7 Churikov D, Siino J, Svetlova M, Zhang K, Gineitis A, Morton
Bradbury E, et al. Novel human testis-specific histone H2B
encoded by the interrupted gene on the X chromosome.
Genomics 2004; 84: 745_56.
8 Singleton S, Mudrak O, Morshedi M, Oehninger S, Zalenskaya
I, Zalensky A. Characterisation of a human sperm cell
subpopulation marked by the presence of the TSH2B histone.
Reprod Fertil Dev 2007; 19: 392_7.
9 Gineitis AA, Zalenskaya IA, Yau PM, Bradbury EM, Zalensky
AO. Human sperm telomere-binding complex involves histone
H2B and secures telomere membrane attachment. J Cell Biol
2000; 151: 1591_8.
10 Bach O, Glander HJ, Scholz G, Schwarz J. Electrophoretic
patterns of spermatozoal nucleoproteins (NP) in fertile men
and infertility patients and comparison with NP of somatic
cells. Andrologia 1990; 22: 217_24.
11 Carrell DT, Liu L. Altered protamine 2 expression is uncommon
in donors of known fertility, but common among men with
poor fertilizing capacity, and may reflect other abnormalities
of spermiogenesis. J Androl 2001; 22: 604_10.
12 de Yebra L, Ballesca JL, Vanrell JA, Bassas L, Oliva R.
Complete selective absence of protamine P2 in humans. J Biol
Chem 1993; 268: 10553_7.
13 Zhang X, San Gabriel M, A Zini A. Sperm nuclear protamine
to histone ratio in fertile and infertile men: evidence of
heterogeneous sub-populations of spermatozoa in the ejaculate.
J Androl 2006; 27: 414_20.
14 Aoki VW, Moskovtsev SI, Willis J, Liu L, Mullen JB, Carrell
DT. DNA integrity is compromised in protamine-deficient
human sperm. J Androl 2005; 26: 741_8.
15 Marzluff WF, Gongidi P, Woods KR, Jin J, Maltais LJ. The
human and mouse replication-dependent histone genes.
Genomics 2002; 80: 487_98.
16 Cho C, Willis WD, Goulding EH, Jung-Ha H, Choi YC, Hecht
NB, et al. Haploinsufficiency of protamine-1 or -2 causes
infertility in mice. Nat Genet 2001; 28: 82_6.
17 World Health Organization. WHO Laboratory Manual for the
Examination of Human Semen and Sperm-Cervical Mucus
Interaction. 4th edn. Cambridge: Cambridge University Press,
1999.
18 Tovich PR, Oko RJ. Somatic histones are components of the
perinuclear theca in bovine spermatozoa. J Biol Chem 2003;
278: 32431_8.
19 Evenson DP, Jost LK, Marshall D, Zinaman MJ, Clegg E,
Purvis K, et al. Utility of the sperm chromatin assay as a
diagnostic and prognostic tool in the human fertility clinic.
Hum Reprod 1999; 14: 1039_49.
20 Evenson DP, Jost LK, Corzett M, Balhorn R. Characteristics
of human sperm chromatin structure following an episode of
influenza and high fever: a case study. J Androl 2000; 21:
739_46.
21 Zini A, Meriano J, Kader K, Jarvi K, Laskin C, Cadesky K.
Potential adverse effect of sperm DNA damage on embryo
quality after ICSI. Hum Reprod 2005; 20: 3476_80.
22 Zini A, Bielecki R, Phang D, Zenzes MT. Correlations between
two markers of sperm DNA integrity, DNA denaturation and
DNA fragmentation, in fertile and infertile men. Fertil Steril
2001; 75: 674_7.
23 Prigent Y, Muller S, Dadoune JP. Immunoelectron microscopical
distribution of histones H2B and H3 and protamines during
human spermiogenesis. Mol Hum Reprod 1996;
2: 929_35.
24 Tanaka H, Iguchi N, Isotani A, Kitamura K, Toyama Y,
Matsuoka Y, et al. HANP1/H1T2, a novel histone H1-like
protein involved in nuclear formation and sperm fertility. Mol
Cell Biol 2005; 25: 7107_19.
25 Aoki VW, Emery BR, Liu L, Carrell DT. Protamine levels
vary between individual sperm cells of infertile human males
and correlate with viability and DNA integrity. J Androl 2006;
27: 890_8.
26 Iguchi N, Yang S, Lamb DJ, Hecht NB. An SNP in protamine
1: a possible genetic cause of male infertility? J Med Genet
2006; 43: 382_4.
27 Evenson DP, Darzynkiewicz Z, Jost L, Janca F, Ballachey B.
Changes in accessibility of DNA to various fluorochromes
during spermatogenesis. Cytometry 1986; 7: 45_53.
28 Singleton S, Zalensky A, Doncel GF, Morshedi M, Zalenskaya
IA. Testis/sperm-specific histone 2B in the sperm of donors
and subfertile patients: variability and relation to chromatin
packaging. Hum Reprod 2007; 22: 743_50.
29 Erenpreiss J, Spano M, Erenpreisa J, Bungum M, Giwercman
A. Sperm chromatin structure and male fertility: biological
and clinical aspects. Asian J Androl 2006; 8: 11_29.
30 Emery BR, Carrell DT. The effect of epigenetic sperm
abnormalities on early embryogenesis. Asian J Androl 2006;
8: 131_42.
31 Spano M, Bonde JP, Hjollund HI, Kolstad HA, Cordelli E,
Leter G, et al. Sperm chromatin damage impairs human
fertility. Fertil Steril 2000, 73: 43_50.
32 Loft S, Kold-Jensen T, Hjollund NH, Giwercman A, Gyllemborg
J, Ernst E, et al. Oxidative DNA damage in human sperm influences
time to pregnancy. Hum Reprod 2003; 18: 1265_72.
33 Duran EH, Morshedi M, Taylor S, Oehninger S. Sperm DNA
quality predicts intrauterine insemination outcome: a
prospective cohort study. Hum Reprod 2002; 17: 3122_8.
34 Bungum M, Humaidan P, Axmon A, Spano M, Bungum L,
Erenpreiss J, et al. Sperm DNA integrity assessment in
prediction of assisted reproduction technology outcome. Hum
Reprod 2007; 22: 174_9.
35 Huang CC, Lin DP, Tsao HM, Cheng TC, Liu CH, Lee MS.
Sperm DNA fragmentation negatively correlates with velocity
and fertilization rates but might not affect pregnancy rates.
Fertil Steril 2005; 84: 130_40.
36 Benchaib M, Lornage J, Mazoyer C, Lejeune H, Salle B,
Francois Guerin J. Sperm deoxyribonucleic acid fragmentation
as a prognostic indicator of assisted reproductive technology
outcome. Fertil Steril 2007; 87: 93_100.
37 Borini A, Tarozzi N, Bizzaro D, Bonu MA, Fava L, Flamigni
C, et al. Sperm DNA fragmentation: paternal effect on early
post-implantation embryo development in ART. Hum Reprod
2006; 21: 2876_81.
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