title: Does human semen contain a functional haemostatic system? A possible role for Tissue Factor Pathway Inhibitor in fertility through semen liquefaction.
abstract: There is already evidence that a few components of the haemostatic system exist in semen. If these comprise a functional system, they may have a role in seminal clotting and liquefaction processes and ultimately may influence fertility. What might be expected in semen as collected from fertility clinics i.e., after having both coagulated and subsequently liquefied is uncertain. It does however still contain significant amounts of Tissue Factor (TF) although its effect on semen quality remains poorly understood. The present study analyses semen for Tissue Factor Pathway Inhibitor (TFPI). Measurements were made in seminal plasma, swim-up sperm and prostasomes and its relationship with conventional fertility parameters assessed. TFPI antigen levels in seminal plasma were measured in a total of 176 subjects using an Enzyme-linked immunosorbent assay (ELISA). These include sub-fertile (n=37), normally fertile (n=40), fertile sperm donor (n=34), vasectomized subjects (n=65) and in a further group defined by normality in several parameters derived from the World Health Organization (WHO) fertility criteria and termed "pooled normal semen parameters" (PNSP). For characterization studies, both TFPI activity and antigen were measured on whole semen, swim-up sperm and prostasome-rich fraction (n=5). TFPI levels were significantly higher in normal men as compared to sub-fertile (P<0.01) or vasectomized subjects (P<0.001). TFPI levels were even higher in the donor quality semen and the PNSP group. TFPI levels also correlated with semen liquefaction time, normal semen viscosity, sperm progression, percentage of motile sperm and sperm counts (density). In conclusion, the present finding substantiates the concept of an active clotting system in human semen. TFPI could regulate the activity of abundant TF, as it does elsewhere. Given a functional set of coagulation factors in semen, the TF/TFPI balance might impinge on its liquefaction and hence on global fertility.
authors.affiliation: Department of Urology, Southampton University Hospitals NHS Trust, UK. bashir@soton.ac.uk
authors.forename: Bashir A
authors.initials: BA
authors.lastname: Lwaleed
authors.forename: Robert S
authors.initials: RS
authors.lastname: Greenfield
authors.forename: Brian R
authors.initials: BR
authors.lastname: Birch
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Cooper
mesh_terms: D000328:Adult; D004797:Enzyme-Linked Immunosorbent Assay; D005298:Fertility; D006487:Hemostasis; D006801:Humans; D007248:Infertility, Male; D008074:Lipoproteins / Q000097:blood* / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D012661:Semen / Q000378:metabolism*; D013076:Sperm Count; D013081:Sperm Motility; D013094:Spermatozoa; D013925:Thromboplastin / Q000378:metabolism; D013997:Time Factors; D014659:Vasectomy
chemical_list: D008074:Lipoproteins; C051928:lipoprotein-associated coagulation inhibitor; D013925:Thromboplastin