Role of the spermatic artery in spermatogenesis and sex hormone synthesis

Spectral Doppler sonography: a noninvasive method for predicting dyspermia

OBJECTIVES

Sonography is a noninvasive, office-based diagnostic tool often used for evaluation of subfertile men. Previous studies have suggested that a resistive index (RI) greater than 0.6 is associated with impaired spermatogenesis. We sought to validate this threshold in a urologic patient population presenting for infertility evaluation.

METHODS

We retrospectively reviewed 99 consecutive patients seen for nonobstructive male infertility at our institution. Patient demographics, semen analysis parameters, hormone profiles, lipid profiles, and penile and scrotal sonographic measurements were recorded. The RI was calculated from measurements of the peak systolic velocity and end-diastolic velocity. Ninety-one patients fit the inclusion criteria and were subsequently divided into 2 groups based on RI: group 1 with RI values of 0.6 or less (n = 49) and group 2 with RI values greater than 0.6 (n = 42).

RESULTS

Variables that were significantly different between the groups included age, total sperm count, percent motile sperm, total motile sperm, follicle-stimulating hormone, high-density lipoprotein, and testis volume. On the other hand, body mass index, forward progression, World Health Organization score, total testosterone, free testosterone, estradiol, total cholesterol, low-density lipoprotein, and triglycerides were not significantly different between the groups. A receiver operating characteristic curve revealed an area under the curve of 0.64 (confidence interval, 0.52-0.75; P = .025). At the threshold of greater than 0.6, the RI had specificity of 63.27% and a 1.56 likelihood ratio to predict total motile sperm less than 20 × 10(6) at spermatogenesis.

CONCLUSIONS

An intratesticular RI greater than 0.6 is associated with impaired spermatogenesis. This finding supports the use of testicular spectral Doppler sonography as a noninvasive tool for evaluation of testicular function.

Oral tamoxifen citrate treatment is more effective in normogonadotropic patients who have follicle-stimulating hormone levels within the lower half of normal

OBJECTIVE

To identify a subgroup of normogonadotropic men who may benefit relatively more from TC (tamoxifen citrate; a widely prescribed drug for male infertility) among those with FSH (follicle-stimulating hormone) values in the lower or higher halves of the normal range.

PATIENTS AND METHODS

In this retrospective study, 120 normogonadotropic infertile men with idiopathic oligozoospermia were included. All patients received 20 mg TC daily as a single dose for 6 months, and semen analysis and hormone levels were analyzed after 6 months, with the values being compared with those before treatment.

RESULTS

The FSH, luteinizing hormone and testosterone levels were significantly increased after the use of oral TC 20 mg daily. The sperm counts of the patients in the lower initial FSH group had a significantly higher increase in sperm count and concentration compared to the relatively higher FSH group.

CONCLUSION

This study revealed that initial FSH values can be used as a marker to estimate the probability that a patient will benefit from oral TC therapy. Patients in the lower FSH group had statistically higher chances of having higher sperm counts after treatment, and it is rational to advise these patients to receive 6 months of oral TC therapy. However, before drawing firm conclusions from this retrospective study, these results should be confirmed with double-blind, placebo-controlled, randomized trials.

Male idiopathic oligoasthenoteratozoospermia

Idiopathic oligoasthenoteratozoospermia (iOAT) affects approximately 30% of all infertile men. This mini-review discussed recent data in this field. Age, non-inflammatory functional alterations in post-testicular organs, infective agents (Chlamydia trachomatis, herpes virus and adeno-associated viruses), alterations in gamete genome, mitochondrial alterations, environmental pollutants and "subtle" hormonal alterations are all considered possible causes of iOAT. Increase of reactive oxygen species in tubules and in seminal plasma and of apoptosis are reputed to affect sperm concentration, motility and morphology. iOAT is commonly diagnosed by exclusion, nevertheless spectral traces of the main testicular artery may be used as a diagnostic tool for iOAT. The following can be considered therapies for iOAT: 1) tamoxifen citrate (20 mg/d) + testosterone undecanoate (120 mg/d) (pregnancy rate per couple/month [prcm]: 3.8%); 2) folic acid (66 mg/d) + zinc sulfate (5 mg/d); 3) L-carnitine (2 g/d) alone or in combination with acetyl-L-carnitine (1 g/d) (prcm: 2.3%); and 4) both carnitines = one 30 mg cinnoxicam suppository every 4 days (prcm: 8.5%). Alpha-blocking drugs improved sperm concentration but not morphology, motility or pregnancy rate. Tranilast (300 mg/d) increased sperm parameters and pregnancy rates in an initial uncontrolled study. Its efficacy on sperm concentration (but not on sperm motility, morphology or prcm) was confirmed in subsequent published reports. The efficacy of tamoxifen + testosterone undecanoate, tamoxifen alone, and recombinant follicle-stimulating hormone is still a matter for discussion.

Intraoperative characterization of arterial vasculature in spermatic cord

OBJECTIVES

To characterize the arterial microanatomy within the spermatic cord.

METHODS

Between June 2002 and March 2003, 72 men underwent 120 microsurgical subinguinal varicocelectomies for the treatment of varicocele. A micro-ruler was used to measure the diameter of each artery in the spermatic cord at the external inguinal ring.

RESULTS

A single testicular artery was identified in 83 (69%), two testicular arteries in 32 (27%), and three arteries in 4 (3%) of 120 cases. The testicular artery diameter ranged from 0.2 to 1.9 mm (mean 1.0). A single vasal artery was identified in 117 (98%) of 120 cases, with the vasal artery diameter ranging between 0.2 and 1.8 mm (mean 0.6). A single cremasteric artery was identified in 66 (55%), two arteries in 37 (31%), and three arteries in 5 (4%) of 120 cases. The cremasteric artery diameter ranged from 0.1 to 1.5 mm (mean 0.5). The diameter of the testicular artery was equal to or greater than the sum of the vasal and cremasteric artery diameters in 69 (57.5%) of 120 spermatic cords.

CONCLUSIONS

The testicular artery was consistently the largest caliber arterial vessel, with a diameter equal to or greater than the sum of the vasal and cremasteric arteries in more than 50% of the spermatic cords. This suggests that although the vasal and cremasteric arteries combined contribute significantly to the testicular blood supply, the testicular artery provides most of the blood flow to the human testes. Preservation of the testicular arteries is recommended for optimal testicular blood flow.

Spermatogenesis and spectral echo-colour Doppler traces from the main testicular artery

OBJECTIVE

To assess whether the peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI) of testicular arteries may be useful in distinguishing the various causes of dyspermia when compared with follicle-stimulating hormone (FSH) and testicular volume.

PATIENTS, SUBJECTS AND METHODS

The study included nine men with obstructive and 20 with unobstruc-tive azoospermia, 17 with oligoasthenospermia and clinical varicoceles, with male accessory glans inflammation (MAGI), 38 with undetermined oligoasthenospermia, 19 with MAGI, 11 with clinical varicoceles, 32 subjects with normal sperm analysis and recent paternity (fertile controls), and 15 with normal sperm analysis and a varicocele with recent paternity (fertile + varicoceles). Testicular volume, FSH, PSV, EDV and RI were compared among the dyspermic and/or control groups using analysis of variance.

RESULTS

The PSV and RI were useful for identifying the different groups of patients, while EDV, FSH and testicular volume were not. Men with varicoceles, varicoceles + MAGI or fertile with varicoceles had the highest PSV and RI; fertile controls, those with obstructive azoospermia and MAGI had similar PSVs and RIs, those with unexplained oligoasthenospermia had a significantly lower PSV and RI, and men with unobstructive azoospermia had the lowest PSV and RI.

CONCLUSIONS

The RI and PSV are reliable indicators for routine clinical use to identify infertile/dyspermic men, while EDV, FSH and testicular volume are not. The RI and especially PSV clearly differentiated obstructive from unobstructive azoospermia.