Introduction: Tissue factor pathway inhibitor (TFPI) is a multivalent Kunitz-type serine proteinase inhibitor, which plays a central role in the extrinsic pathway of blood coagulation. It inhibits activated factor X directly and factor VIIa/tissue factor via a quaternary complex. The composition of human semen is governed by the ejaculatory mixing of sperm-rich epididymal fluid, with secretion provided by the accessory sex glands. It is composed of more than 30 proteins including coagulation and liquefaction proteins. Ovarian follicular fluid plays an important biological role in folliculogenesis and oocyte maturation, and it remains in a hypocoagulable state until ovulation.
Materials and methods: TFPI levels were measured in ovarian follicular fluid gained from the punctured follicles of superovulated women (n=70), and, for the first time, in seminal plasma of 28 healthy ejaculate donors and 23 infertile patients with oligozoospermia, asthenozoospermia, or teratozoospermia.
Results: TFPI concentrations determined in liquor folliculi (median 298 ng/ml, 90% range 109-648 ng/ml) were four times higher than the levels found in human blood of healthy individuals. TFPI concentrations in seminal plasma samples of infertile men were significantly reduced (median 2.20 ng/ml, 90% range 0.28-6.02 ng/ml, p<0.07) in comparison to healthy donors (median 3.55 ng/ml, 90% range 0.93-7.90 ng/ml).
Conclusions: The high TFPI levels measured in the ovarian follicular fluid underline the physiological importance of this inhibitor for maintaining the hypocoagulable state. The decreased TFPI concentrations in seminal plasma of infertile men support the possible correlation between the coagulation properties of ejaculated semen and male fertility.