Evaluation of intracellular anion superoxide level, heat shock protein A2 and protamine positive spermatozoa percentages in teratoasthenozoospermia

Background: Teratoasthenozoospermia (TA) is a severe form of male infertility with no clear etiology.
Objective: To compare the level of intracellular anion superoxide (O₂–), heat shock protein A2 (HSPA2) and protamine deficiencies in ejaculated spermatozoa between teratoasthenozoospermic and normozoospermic men.
Materials and Methods: In this case- control study, semen samples of 20 infertile men, with TA (with normal morphology lower than 4% and total motility lower than 40% ) as the case group and 20 normozoospermic fertile men as the control group were evaluated for intracellular O₂^– and HSPA2 by flow cytometry and protamine deficiency by Chromomycin A3 (CMA3) test.
Results: The rate of CMA3+ spermatozoa in the case group was higher than controls (p=0.001). The percentages of HSPA2+ spermatozoa in the cases were significantly lower than controls (p=0.001). Also, intracellular O₂ – levels in the case group were significantly higher than controls (p=0.001) and had positive correlations with sperm apoptosis (r=0.79, p=0.01) and CMA3 positive sperm (r=0.76, p=0.01), but negative correlations with normal morphology (r=-0.81, p=0.01) and motility (r=-0.81, p=0.01). There was no significant correlation between intracellular O₂ ^– and HSPA2 in the case group (r=0.041, p=0.79).
Conclusion: We suggest that the increase in intracellular O₂ ^–, decrease in spermatozoa HSPA2⁺, and high percentages of spermatozoa with immature chromatin might be considered as etiologies of infertility in TA patients.