Hyperprolactinemia: histological and meiotic analyses in azoospermic men

Relationship between hormone levels and testicular biopsies of azoospermic men

This study was conducted to evaluate the testicular biopsies and the sera levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), testosterone (T), and prolactin (PRL) in 96 azoospermic men attending the Andrology Clinic. Plasma levels of FSH were the most common hormone abnormality in the evaluation of azoospermia. Plasma levels of LH and T were useful only in azoospermic men with hypogonadism, whereas plasma PRL levels rarely occurred in azoospermia.

Physiopathology of spermatogenic arrest

OBJECTIVE

To review the world literature on the etiology, physiopathology, and treatment of spermatogenesis arrest.

STUDY SELECTION

All the pertinent literature on spermatogenic arrest has been selected. Most studies related to this topic have been identified through Medline and through published literature.

PATIENTS

Spermatogenic arrest has been diagnosed by testicular biopsy in men of reproductive age who had either severe oligospermia (partial arrest) or azoospermia (complete arrest), normal testicular volume, and depending on the etiology normal, high, or low levels of gonadotropins.

INTERVENTIONS

The effects of heat, radiotherapy, and chemotherapy have been reported. Depending on the etiology of spermatogenic arrest, different hormonal treatments have been tested.

MAIN OUTCOME MEASURE

Level of interruption of germ cell differentiation in testicular biopsy have been determined. Improvement of the sperm count or appearance of mature sperm after an hormonal treatment have been observed.

RESULTS

Spermatogenic arrest can occur at spermatogonial level in case of gonadotropin insufficiency or after germ cell damage due to chemotherapy or radiotherapy. The arrest is most frequently observed at primary spermatocyte level. Reversible arrest at that level can be due to heat, infections, hormonal and nutritional factors. Irreversible arrest at primary spermatocyte or spermatid level have a genetic origin due to chromosomes anomalies either in somatic cells or in germ cells.

CONCLUSIONS

Spermatogenic arrest is usually due to genetic factors resulting in irreversible azoospermia. However some cases may be consecutive to hormonal, thermic, or toxic factors and may be reversible either spontaneously or after a specific treatment.

Incidence of aetiological factors in testicular obstructive azoospermia

Testicular exploration was performed in 225 azoospermic men with normal sized testes and normal serum levels of FSH. Thirty-one men had impaired spermatogenesis and the cause of obstruction was found in 46% of the subjects. Thirty-two men had a history of genital tract infection while 18 had a history of genital or inguinal surgery. A history of chest disease was noted in 25 men with obstructive azoospermia. Aplasia of the vasa was present in 9.3% of the group. The epididymis was the site of obstruction in 63% of patients but the cause of epididymal obstruction was unknown in 81 of the 141 men.

Hormone profile in hyperprolactinemic infertile men

Serum levels of FSH, LH, prolactin, testosterone, and estradiol in 46 infertile men with hyperprolactinemia were compared with the same in 50 infertile and 30 fertile men with normal serum prolactin levels. Serum FSH levels in hyperprolactinemic men were significantly higher than in the other groups, indicating disturbance of spermatogenic process among those men. Significantly raised serum LH levels were in infertile men with serum prolactin over 1000 U/liter. All men with hyperprolactinemia had significantly lower serum testosterone levels than other infertile and fertile men. Although serum testosterone was not under the lower limit of normal range and high LH levels demonstrated disturbance of Leydig cell function in hyperprolactinemic infertile men, serum estradiol levels were not different among investigated groups. Azoospermic men with raised serum prolactin had higher serum FSH and LH levels than oligospermic men with hyperprolactinemia. These data demonstrated disturbance in hypothalamopituitary-testicular axis in infertile men with hyperprolactinemia. Further studies of prolactin in males with reproductive failure could probably clear this problem.

Endocrine profile of 45 patients with Sertoli cell only syndrome

The basal serum levels of FSH, LH, prolactin and testosterone were determined in 45 patients with Sertoli cell only syndrome and were compared with the same in patients with Klinefelter's syndrome, oligozoospermic men and normal, fertile men. The serum FSH and LH levels in patients with Sertoli cell only syndrome were significantly higher than in normal males. The elevation of gonadotropins in patients with this syndrome was not so high, and the testosterone not lowered, as those in patients with Klinefelter's syndrome. The finding that the basal serum LH levels were elevated and serum testosterone levels were in normal range, demonstrated that there was compensated dysfunction of the Leydig cells in patients with Sertoli cell only syndrome.