[Impact of plateau environment on seminal characteristics of native Tibetans and immigrated Tibetan Hans]

OBJECTIVE

To investigate the characteristics of the semen parameters of native Tibetans and immigrated Tibetan Hans in the high-altitude area and analyze the influence of altitude adaptation on male fertility.

METHODS

This study included 1 563 infertile male patients, including 698 native Tibetans and 865 immigrated Tibetan Hans, and 56 normal fertile men, including 33 native Tibetans and 23 Tibetan Hans. We obtained semen samples from the subjects for routine semen analysis and sperm DNA fragmentation index (DFI) examination and collected peripheral blood for determination of the reproductive hormone levels.

RESULTS

In the infertile patients, the native Tibetans, as compared with the immigrated Hans, showed significantly higher incidence rates of azoospermia (5.87% vs 2.89%, P <0.05), severe oligozoospermia (3.15% vs 1.73%, P <0.05) and abnormal seminal viscosity (43.12% vs 25.89%, P<0.01), but no statistically significant differences in the percentages of normozoospermia (81.08% vs 87.39%, P >0.05), oligozoospermia (5.44% vs 3.93%, P >0.05), severe asthenozoospermia (4.44% vs 4.04%, P >0.05) or severe teratozoospermia (4.58% vs 6.59%, P >0.05). In the normal fertile men, there were no statistically significant differences between the native Tibetans and immigrated Hans in age (［32.42 ± 4.82］ vs ［34.57 ± 6.01］ yr, P >0.05), sperm concentration (［143.69 ± 85.74］ vs ［155.11 ± 82.56］ ×10⁶/ml, P >0.05), straight line velocity (［25.74 ± 3.94］ vs ［27.24 ± 3.46］ μm/s, P >0.05), percentage of morphologically normal sperm (［8.22 ± 4.35］ vs ［7.28±2.46］ %, P >0.05), total testosterone concentration (［17.97 ± 2.98］ vs ［15.72 ± 6.38］ nmol/L, P >0.05), or follicle stimulating hormone level (［5.51 ± 1.62］ vs ［4.17 ± 2.08］ IU/L, P >0.05). However, the immigrated Hans, in comparison with the native Tibetans, exhibited a higher sperm motility (［79.75 ± 14.67］ vs ［66.58 ± 17.21］%, P <0.05), a lower curvilinear velocity (［60.97 ± 2.71］ vs ［71.14 ± 82.13］ μm/s, P <0.05) and a lower level of luteinizing hormone (［4.28 ± 1.20］ vs ［5.84 ± 1.15］ IU/L, P <0.05).

CONCLUSIONS

During the acclimatization to the plateau hypoxia environment, the immigrated Tibetan Hans undergo adaptive changes in sperm concentration and motility and have lower incidence rates of azoospermia and severe oligozoospermia than native Tibetan males.

[Acupuncture treatment of oligoasthenozoospermia]

Studies show that acupuncture can significantly elevate the level of serum testosterone (T), reduce the concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2), initiate spermatogenesis, enhance testicular blood flow, maintain a relative low temperature in the testis, increase the concentration, motility and antioxidative injury capability of spermatozoa by raising the levels of seminal α-glucosidase, fructose and super oxide dismutase, and eventually improve semen quality and the rate of conception in the treatment of oligoasthenozoospermia. Currently, the quality of the clinical studies of acupuncture treatment of oligoasthenozoospermia is relatively poor, the existing evidence remains at a low level, its clinical application is limited, and its therapeutic effect has to be further verified. The present paper summarizes the literature from domestic and international databases about acupuncture treatment of oligoasthenozoospermia, and offers an overview of the effects of acupuncture on the reproductive endocrine system, testicular blood flow, semen quality, and rate of conception in the treatment of the patient.

[Mid-frequency transcutaneous electrical acupoint stimulation combined with tamoxifen for the treatment of oligoasthenozoospermia]

OBJECTIVE

To explore the feasibility, safety and clinical effect of mid-frequency transcutaneous electrical acupoint stimulation (TEAS) combined with oral tamoxifen (TAM) in the treatment of oligoasthenozoospermia.

METHODS

We randomly and equally assigned 120 patients with idiopathic oligoasthenozoospermia to receive oral TAM, mid-frequency TEAS, or TAM+TEAS, all for 8 weeks. Before and after treatment, we recorded the semen volume, total sperm count, sperm concentration, sperm motility, percentage of progressively motile sperm (PMS), and the levels of follicle-stimulating hormone (FSH), luteotrophic hormone (LH) and testosterone (T) in the peripheral serum and compared these parameters among the three groups of patients.

RESULTS

Compared with the baseline, none of the patients showed significant improvement in the semen volume (P >0.05) but all exhibited remarkably elevated levels of serum FSH, LH and T after treatment (P <0.05); TAM significantly improved the total sperm count (［25.16 ± 2.05］ vs ［42.65 ± 5.78］ ×106, P <0.05) and sperm concentration (［12.15 ± 2.51］ vs ［24.31 ± 2.59］ ×10⁶/ml, P <0.05), but not total sperm motility (［21.78 ± 8.81］ vs ［22.61 ± 5.75］ %, P >0.05) or PMS (［15.87 ± 7.81］ vs ［16.76 ± 5.86］ %, P >0.05); TEAS markedly increased total sperm motility (［24.81 ± 8.27］ vs ［32.43 ± 4.97］ %, P <0.05) and PMS (［19.71 ± 9.15］ vs ［27.17 ± 5.09］%, P <0.05), but not the total sperm count (［23.23 ± 3.14］ vs ［25.87 ± 4.96］ ×106, P >0.05) or sperm concentration (［11.27 ± 2.24］ vs ［14.12 ± 2.47］ ×10⁶/ml, P >0.05); TAM+TEAS, however, improved not only the total sperm count (［26.17 ± 5.05］ vs ［ 51.14 ± 3.69］×106, P <0.05) and sperm concentration (［12.78 ± 2.41］ vs ［27.28 ± 1.98］ ×10⁶/ml, P <0.05), but also total sperm motility (［23.89 ± 9.05］ vs ［37.12 ± 5.33］%, P <0.05) and PMS (［17.14 ± 8.04］ vs ［31.09 ± 7.12］%, P <0.05). The total effectiveness rate was significantly higher in the TAM+TEAS group than in the TAM and TEAS groups (97.5% vs 72.5% and 75.0%, P <0.05).

CONCLUSIONS

Mid-frequency TEAS combined with tamoxifen can significantly improve semen quality and increase sex hormone levels in patients with idiopathic oligoasthenozoospermia.

[Correlation of serum anti-Müllerian hormone with semen parameters]

OBJECTIVE

To investigate the relationship between the serum anti-Müllerian hormone (AMH) level and semen parameters.

METHODS

We collected the data about 726 outpatients at the Male Infertility Clinic of Jinling Hospital from September 2015 to November 2016, including 72 with non-obstructive azoospermia, 123 with oligospermia, and 531 with normal sperm concentration. We obtained the semen volume, total sperm count, sperm concentration, sperm motility, the percentages of progressively motile sperm (PMS) and morphologically normal sperm (MNS), and the levels of serum AMH, inhibin B (INH-B), total testosterone (TT) and follicle - stimulating hormone (FSH) of the patients, analyzed the correlation of the serum AMH level with the other parameters, and compared the AMH level among different groups.

RESULTS

The serum AMH level was found to be correlated positively with the total sperm count (r = 0.227, P <0.001), sperm concentration (r = 0.215, P <0.001), sperm motility (r = 0.111, P = 0.003), the percentage of PMS (r = 0.120, P = 0.001), and the levels of INH-B (r = 0.399, P <0.001) and TT (r = 0.184, P = 0.002), negatively with the FSH level (r = －0.283, P <0.001), but insignificantly with age, time of abstinence, semen volume, and the percentage of MNS (P >0.05). There was a statistically significant difference in the serum AMH level among the patients with non-obstructive azoospermia, oligozoospermia, and normal sperm concentration (［6.33 ± 4.26］ vs ［8.26 ± 3.98］ vs ［9.8 ± 5.19］ ng/ml, P <0.001).

CONCLUSIONS

Serum AMH is a biomarker reflecting the function of Sertoli cells and its level is significantly correlated with sperm concentration and motility, suggesting that AMH may be involved in spermatogenesis and sperm maturation.

THE PECULIARITIES OF ARGINASE PATHWAY OF L-ARGININE IN SPERMATOZOA IN MEN WITH DIFFERENT FORMS OF PATHOSPERMIA

The changes in arginase activity of spermatozoa and hormonal profile of peripheral blood of infertile men with various forms pathospermia have been studied. It has been found that arginase activity in the sperm cells of men with oligozoo-, antenozoo-, oligoastenozoo- and leucocytospermia is decreased in 2.1, 2.3, 2.4 and 3.3 times respectively. This indicates about inhibition of arginase pathway of L-arginine metabolism, which is not significantly dependent on the type of disruption of spermatogenesis. The most significant changes have been observed in infertile men with leucocytospermia since white blood cells stimulate the formation of reactive oxygen species, induction and development of oxidative and nitrative stress in spermatozoa. Inhibition of arginase pathway of L-arginine metabolism has adaptive role, which is to limit bioavailabil- ity of L-arginine and to prevent excessive formation of NO in cytotoxic concentrations to sperm cells. It has been noted changes in serum concentrations of gonadotropin and sex hormones in men with various forms of pathospermia. The most expressed significant changes were in levels of follicle stimulating hormone and testosterone. The concentration of follicle stimulating hormone in patients with oligozoospermia caused by hypogonadism is twice higher and in patients with leucocytospermia in 1.8 times higher than in fertile men. In patients with astenozoospermia this value is in 2.2 times lower than in normozoospermic samples but within the physiological norm. The testosterone level in men with oligozoospermia is in 1.6 times lower than in fertile men but within the physiological norm. It has been found that arginase inhibition of spermatozoa po6itively correlated with a decrease in their concentration in the ejaculate of infertile men with oligozoospermia (r =0.68).

Enclomiphene citrate stimulates testosterone production while preventing oligospermia: a randomized phase II clinical trial comparing topical testosterone

OBJECTIVE

To determine the effect of enclomiphene citrate in men with secondary hypogonadism.

DESIGN

Phase II clinical trial.

SETTING

Community dwelling men making visits to physician offices.

PATIENT(S)

Men with secondary hypogonadism.

INTERVENTION(S)

Oral administration of enclomiphene citrate or 1% topical T gel.

MAIN OUTCOME MEASURE(S)

Luteinizing hormone, FSH, T, and semen analysis.

RESULT(S)

Treatment with enclomiphene citrate resulted in increased morning serum T, E2, and LH levels similar to those obtained with a topical T gel in men with secondary hypogonadism. Follicle-stimulating hormone and LH were increased with enclomiphene, and sperm counts were conserved.

CONCLUSION(S)

Enclomiphene citrate reverses the two hallmarks of secondary hypogonadism, namely, low serum total T and low or inappropriately normal LH while preserving sperm production.

CLINICAL TRIAL REGISTRATION NUMBER

NCT01270841 (ClinicalTrials.gov Identifier NCT01270841).

Reproductive physiology in young men is cumulatively affected by FSH-action modulating genetic variants: FSHR -29G/A and c.2039 A/G, FSHB -211G/T

Follicle-Stimulating Hormone Receptor (FSHR) -29G/A polymorphism (rs1394205) was reported to modulate gene expression and reproductive parameters in women, but data in men is limited. We aimed to bring evidence to the effect of FSHR -29G/A variants in men. In Baltic young male cohort (n = 982; Estonians, Latvians, Lithuanians; aged 20.2±2.0 years), the FSHR -29 A-allele was significantly associated with higher serum FSH (linear regression: effect 0.27 IU/L; P = 0.0019, resistant to Bonferroni correction for multiple testing) and showed a non-significant trend for association with higher LH (0.19 IU/L) and total testosterone (0.93 nmol/L), but reduced Inhibin B (−7.84 pg/mL) and total testes volume (effect −1.00 mL). Next, we extended the study and tested the effect of FSHR gene haplotypes determined by the allelic combination of FSHR -29G/A and a well-studied variant c.2039 A/G (Asn680Ser, exon 10). Among the FSHR -29A/2039G haplotype carriers (A-Ser; haplotype-based linear regression), this genetic effect was enhanced for FSH (effect 0.40 IU/L), Inhibin B (−16.57 pg/mL) and total testes volume (−2.34 mL). Finally, we estimated the total contribution of three known FSH-action modulating SNPs (FSHB -211G/T; FSHR -29G/A, c.2039 A/G) to phenotypic variance in reproductive parameters among young men. The major FSH-action modulating SNPs explained together 2.3%, 1.4%, 1.0 and 1.1% of the measured variance in serum FSH, Inhibin B, testosterone and total testes volume, respectively. In contrast to the young male cohort, neither FSHR -29G/A nor FSHR haplotypes appeared to systematically modulate the reproductive physiology of oligozoospermic idiopathic infertile patients (n = 641, Estonians; aged 31.5±6.0 years). In summary, this is the first study showing the significant effect of FSHR -29G/A on male serum FSH level. To account for the genetic effect of known common polymorphisms modulating FSH-action, we suggest haplotype-based analysis of FSHR SNPs (FSHR -29G/A, c.2039 A/G) in combination with FSHB -211G/T testing.

Male infertility: decreased levels of selenium, zinc and antioxidants

In this study, we aimed to compare the level of zinc, selenium, glutathione peroxidase activity and antioxidant status in following populations of men: severe inflammation in prostate (>10(6) white blood cells in prostate secretion; n=29), severe leukocytospermia, (>10(6) white blood cells in semen; n=31), mild inflammation, (0.2-1M white blood cells in semen or prostate secretion; n=24), non-inflammatory oligozoospermia (n=32) and healthy controls (n=27). Male partners of infertile couples had reduced level of antioxidative activity, selenium and zinc in their seminal plasma. Most importantly, reduced selenium levels were evident in all patient groups regardless of inflammation status. Therefore, these patients might gain some benefit from selenium supplementation.

Protective effects of seahorse extracts in a rat castration and testosterone-induced benign prostatic hyperplasia model and mouse oligospermatism model

This study investigated the effects of seahorse (Hippocampus spp.) extracts in a rat model of benign prostatic hyperplasia (BPH) and mouse model of oligospermatism. Compared to the sham operated group, castration and testosterone induced BPH, indicated by increased penile erection latency; decreased penis nitric oxide synthase (NOS) activity; reduced serum acid phosphatase (ACP) activity; increased prostate index; and epithelial thickening, increased glandular perimeter, increased proliferating cell nuclear antigen (PCNA) index and upregulation of basic fibroblast growth factor (bFGF) in the prostate. Seahorse extracts significantly ameliorated the histopathological changes associated with BPH, reduced the latency of penile erection and increased penile NOS activity. Administration of seahorse extracts also reversed epididymal sperm viability and motility in mice treated with cyclophosphamide (CP). Seahorse extracts have potential as a candidate marine drug for treating BPH without inducing the side effects of erectile dysfunction (ED) or oligospermatism associated with the BPH drug finasteride.

High expression of follicle stimulating hormone receptor in testicular tissue of idiopathic azoospermic patients with severe spermatogenic defects

BACKGROUND

Follicle stimulating hormone is necessary for normal reproduction in men. The biochemical actions of follicle stimulating hormone result from binding to the follicle stimulating hormone receptor in the plasma membrane of Sertoli cells. Here, we investigated the expression of the follicle stimulating hormone receptor in different testicular histological phenotypes of patients with idiopathic azoospermia.

METHODS

Fifty-seven cases of idiopathic azoospermia were classified into three groups according to the results of testicular biopsy: patients with hypospermatogenesis, patients with maturation arrest, and patients with Sertoli cell-only syndrome. Thirteen azoospermic patients identified by testicular biopsy as being capable of completing spermatogenesis acted as the control group. Immunohistochemistry and real-time quantitative reverse-transcriptase polymerase chain reaction were performed in each case, and the serum hormone level was also measured in all patients.

RESULTS

The serum follicle stimulating hormone level in patients with Sertoli cell-only syndrome was significantly higher than in patients with hypospermatogenesis, maturation arrest, and complete spermatogenesis (P < 0.01). The serum follicle stimulating hormone level in patients with maturation arrest was significantly higher than in patients with hypospermatogenesis and complete spermatogenesis (P < 0.05). There was no difference in serum follicle stimulating hormone levels in patients with hypospermatogenesis and complete spermatogenesis. The follicle stimulating hormone receptor expression level of testicular samples with Sertoli cell-only syndrome was significantly higher than in those with hypospermatogenesis, maturation arrest, and complete spermatogenesis (P < 0.05), but no significant difference was observed among hypospermatogenesis, maturation arrest, and complete spermatogenesis testicular samples.

CONCLUSIONS

Different serum follicle stimulating hormone levels and follicle stimulating hormone receptor expression were found in the different testicular histology phenotypes in azoospermic patients. Differential follicle stimulating hormone receptor expression in testicular tissue of patients with idiopathic azoospermia may be associated with the degree of spermatogenesis.

The role of hormones on semen parameters in patients with idiopathic or varicocele-related oligoasthenoteratozoospermia (OAT) syndrome

BACKGROUND

Oligoasthenoteratozoospermia (OAT) syndrome is the most frequently seen phenotype in male infertility. Spermatogenesis relies closely on hormone regulation. The aim of this study was to assess the correlation between hormone profile and semen parameters in infertile men with idiopathic or varicocele-related OAT syndrome. We tried to illustrate the correlative factors for better semen parameters in these patients.

METHODS

A total of 96 patients with idiopathic or varicocele-related OAT were included for assessment. Serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), estradiol (E2), prolactin (PRL), and the combinative ratios of these hormones, such as T/E2, T/FSH, T/LH, T/(FSH × LH), PRL × T/FSH, PRL × T/LH, PRL × T/(FSH × LH), were compared individually with sperm parameters. The parameters included sperm concentration, total sperm count (TC), percent motile sperm count, percent normal sperm count, total motile sperm count (TMC), total normal sperm count (TNC), and total motile normal sperm count (TMNC).

RESULTS

T correlated well with percent normal sperm count (p = 0.031). PRL positively correlated with sperm concentration (p = 0.019), TMC (p < 0.001), TNC (p = 0.003), and TMNC (p < 0.001). In hormonal combinative ratios, T/FSH, T/LH, T/(FSH × LH), PRL × T/FSH, PRL × T/LH, and PRL × T/(FSH × LH) all showed significant correlations to concentration and count-related parameters including TC, TMC, TNC, and TMNC.

CONCLUSION

For patients with OAT syndrome, T, PRL, T/FSH, T/LH, T/(FSH × LH), PRL × T/FSH, PRL × T/LH, and PRL × T/(FSH × LH) may be used as predictive markers for better semen quality. This investigation could be a catalyst for future studies on the extent to which manipulating the hormonal combinative ratios can affect the quality of spermatogenesis in infertile males with OAT syndrome.

[Qilin pills combined with bromocriptine for idiopathic hyperprolactinemic oligoasthenozoospermia]

OBJECTIVE

To observe the therapeutic effect of Qilin Pills combined with bromocriptine on idiopathic hyperprolactinemic (HPRL) oligoasthenospermia.

METHODS

We conducted a randomized controlled study on 40 cases of idiopathic HPRL oligoasthenospermia, who were equally assigned to a trial group and a control group to be treated with Qilin Pills (6 g tid) combined with bromocriptine and bromocriptine alone, respectively, both for a course of 12 weeks. Then we observed the changes in the semen volume, sperm concentration, sperm motility and the levels of serum prolactin and testosterone, and compared the therapeutic results between the two groups before and after medication.

RESULTS

Compared with the parameters before medication, both the trial and the control group showed significant improvement after treatment in sperm concentration ([11.60 +/- 3.90] x 10(6)/ml vs [28.10 +/- 13.50] x 10(6)/ml and [12.03 +/- 4.10] x 10(6)/ml vs [18.85 +/- 8.50] x 10(6)/ml), the percentage of grade a sperm ([8.75 +/- 6.65]% vs [24.35 +/- 13.25 ]% and [8.70 +/- 6.70] % vs [19.65 +/- 10.05]%), the percentage of grade a + b sperm ( [28.45 +/- 11.35]% vs [45.80 +/- 16.55]% and [27.65 +/- 10.65]% vs [35.66 +/-13.25]%), and sperm motility ([38.22 +/- 16.35]% vs [60.05 +/- 20.65]% and [37.25 +/- 15.75 ]% vs [52.65 +/- 18.25 ]%) (all P<0.01). No significant differences were found in semen volume (P>0.05). The serum prolactin levels were significantly decreased in the trial and control groups ([152.00 +/- 22.32] and [160.45 +/- 26.65] mIU/L), as compared with premedication ([482.25 +/- 65.32] and [477.32 +/- 60.25] mIU/L) (P<0.01), while the serum testosterone levels were remarkably higher ([16.35 +/- 5.52] and [11.15 +/- 4.65] nmol/L) than before treatment ([3.75 +/- 1.10] and [4.05 +/- 1.30] nmol/L) (P<0.01). There were no statistically significant differences in the serum prolactin and testosterone levels between the two groups after treatment (P>0.05).

CONCLUSION

Qilin Pills combined with bromocriptine have a significantly better efficacy than bromocriptine alone in the treatment of idiopathic HPRL oligoasthenospermia.

[Prevalence of retrograde ejaculation in infertility associated to hypospermia]

BACKGROUND

Approximately 14% of couples of reproductive age have a fertility problem, defined as the inability to achieve pregnancy after a year of frequent intercourse without contraceptive protection.

OBJECTIVE

To determine the prevalence of retrograde ejaculation in infertile patients with hypospermia and to establish the effects of the treatment.

MATERIAL AND METHOD

Comparative study. A semen analysis of 207 patients with male infertility with hypospermia was performed. The patients with retrograde ejaculation were identified and its prevalence was calculated. Semen parameters were compared before and after treatment by means of a paired-t test. Hormonal levels also were compared between groups with and without retrograde ejaculation by means of a Mann-Whitney U test.

RESULTS

Prevalence of retrograde ejaculation was 3.2% out of 2587 infertile patients. Within the group of 207 patients with hypospermia, 84 had retrograde ejaculation. After the treatment the seminal volume increased (from 1.2 to 1.5 milliliters) and the number of mobile cells increased (from 47.2 to 62.5 millions). The number of sperm in urine decreased (from 22 to 10 per high-power field). The patients with retrograde ejaculation had lower levels of follicle-stimulating hormone, luteinizing hormone and testosterone than those without retrograde ejaculation.

CONCLUSIONS

Retrograde ejaculation and hypospermia are both considered infrequent but important alterations in infertility. Prevalence of retrograde ejaculation in patients with hypospermia is 40.5%. Treatment increased seminal volume and the number of mobile cells in the ejaculated semen. It is necessary to perform future studies in order to determine the impact of severity of retrograde ejaculation on infertility.

Inhibin B and FSH as markers of Sertoli cell function in impaired spermatogenesis

INTRODUCTION

The relationships between inhibin B, FSH and sperm count have never been fully elucidated. Our aim was to search for associations between serum concentrations of inhibin B/FSH and the impairment of spermatogenesis.

MATERIAL AND METHODS

In an observational study, we compared sperm count, serum levels of inhibin B and FSH in men with oligozoospermia (n = 46) and in normozoospermic, fertile controls (n = 38).

RESULTS

Concentration of FSH was 10.27 ± 11.24 IU/L in the oligozoospermic and 3.84 ± 2.76 IU/L in the normospermic group (p 〈 0.01). Although the concentration of inhibin B was higher in the oligozoospermic group (424 ± 443 v. 297 ± 219 pg/mL), the difference was statistically insignificant.

CONCLUSIONS

Our results suggest that there is a tendency toward increased serum inhibin B levels in subjects with altered sperm count and increased serum FSH.

Serum levels of steroid hormones in men with varicocele and oligospermia as compared to normozoospermic men

In order to assess the contribution of individual steroidogenic organs to over-all steroid biosynthesis, the basal plasma levels of six hormonal steroids, reflecting the function of gonads and adrenals, as well as both gonadotropins and prolactin, have been determined in 63 oligo- and/or asthenozoospermic men with palpable varicocele, confirmed in each case by sonography. The values obtained were compared with the results of a group of age-matched normospermic men without endocrine disorders. Insignificantly lower levels of testosterone accompanied by significantly lower levels of dihydrotestosterone, slightly decreased LH but increased FSH undistinguishable concentrations of cortisol in patients with varicocele were in agreement with previous findings. Higher levels of an exclusively adrenal androgen 11 beta-hydroxyandrostenedione in men with varicocele indicate increased activity of the adrenal cortex. Significantly higher basal levels of 17 alpha-hydroxyprogesterone in the patient group (p < 0.001), so far not unequivocally proved, evidence for suggested decreased enzyme activity of C17-20 lyase in the testis in at least some of men with varicocele.

PROBABILITY OF SPERM RECOVERY IN NON-OBSTRUCTIVE AZOOSPERMIC PATIENTS PRESENTING WITH TESTES VOLUME LESS THAN 10 ml/FSH LEVEL EXCEEDING 20 mIU/ml

We evaluated the sperm recovery rate in non-obstructive azoospermia (NOA) patients presenting with bilateral testicular atrophy characterized by testes volume of less than 10ml and FSH levels exceeding 20 mIU/ml (group NOA-1), and compared the results to those NOA cases displaying unilateral testis volume exceeding 10 ml or FSH levels less than 20 mIU/ml (group NOA-2). Sperm retrieval was conducted in 261 azoospermic patients from April 1995 to December 2002. Forty-six NOA-1 and 37 NOA-2 individuals underwent microdissection TESE or 3-4 standard biopsies. Sperm recovery was achieved in 11 (24%) and 12 (32%) cases in NOA-1 and NOA-2, respectively. All couples received ICSI. Four clinical pregnancies (36.3%) in NOA-1 and two (17%) in NOA-2 resulted. Five subsequent healthy deliveries were obtained. NOA patients presenting with bilateral severe atrophic testes volume and obviously elevated FSH levels exhibited approximately 24% probability of sperm recovery. On the other hand, NOA characterized by testicular atrophy or elevated FSH levels displayed probability of approximately 32%. Differences in sperm recovery were not evident between NOA-1 and NOA-2. No successful pre-operative predictors of sperm recovery were identified.

Increased Total Antioxidant Capacity in Seminal Plasma of Varicocele Patients: A Multivariate Analysis

To investigate seminal antioxidant systems and their correlation with hormonal pattern in varicocele patients, we studied 33 varicocele (VAR) patients (12 oligozoospermic, 21 normozoospermic) and 34 non-VARs (10 idiopathic oligozoospermic, 24 normozoospermic). Non-enzymatic total antioxidant capacity (TAC) was measured using H(2)O(2)-metamyoglobin, which generates the radical form, spectroscopically detectable, of the chromogen 2,2',-azinobis-3-ethylbenzothiazoline-6-sulphonate (ABTS): time till appearance (Lag) of ABTS*(-) signifies antioxidant concentration. Lag was significantly longer in VARs than controls suggesting ineffective utilization of antioxidants. A significant direct correlation (r = 0.65, p < 0.01) of Lag with sperm count was observed in non-VARs, while in VARs it was inverted, as well as with hematic FSH levels. A multivariate analysis including FSH, Lag, progressive spermatozoa, oligozoospermia and varicocele indicated a strong inverse correlation between FSH and motility (r(2) = 0.31, p > F = 0.0007), not modified by Lag (r(2) = 0.31, p > F = 0.002). Their inverse correlation with Lag may suggest that higher FSH levels, improving sperm antioxidant efficiency, counterbalance varicocele-induced dyspermia.

Semen parameters and hormonal profile in obese fertile and infertile males

OBJECTIVE

To study the changes in semen parameters, gonadotropic and sex hormones, and serum leptin in obese fertile and infertile oligozoospermic men.

DESIGN

Prospective.

SETTING

University hospital.

PATIENT(S)

Forty-two obese fertile and 80 obese infertile oligozoospermic men (body mass index [BMI] >30).

INTERVENTION(S)

The BMI calculation, semen analysis, and serum FSH, LH, T, E(2), PRL, and leptin estimation.

MAIN OUTCOME MEASURE(S)

Semen and hormonal profiles.

RESULT(S)

Obese oligozoospermic patients had significant increase in mean BMI, serum FSH, LH, E(2), PRL, and leptin compared with obese fertile controls. The BMI had significant positive correlation with abnormal sperm morphology, LH, serum leptin and significant negative correlation with sperm concentration, sperm motility, serum T. Serum leptin demonstrated significant positive correlation with patients' age, abnormal sperm morphology, serum FSH, LH, PRL and significant negative correlation with sperm concentration, sperm motility, and serum T.

CONCLUSION(S)

Serum leptin mediates a link between obesity and male infertility.

Increased serum FSH levels correlated with low and high sperm counts in male infertile patients

Serum FSH, LH and testosterone were measured in 57 (42) normal men and in 80 male infertile patients. In the former, mean (x) FSH was found to be 2.5 ng/ml with a range (x +/- 2 SD) from 0.25 ng/ml to 5.3 ng/ml, mean LH was 2.2 ng/ml with a range from 0.5 ng/ml to 5.6 ng/ml, and mean testosterone was 540 ng/100 ml with a range from 190 mg/ml to 890 ng/100 ml. Immunoassayable FSH was found to be elevated in 17 out of 42 presumably infertile males with sperm counts below 20 million/ml, and in 5 out of 12 men with sperm counts above 120 million/ml. There was no correlation between testosterone and sperm number, motility, and seminal fructose content. The concurrence of depressed spermatogenesis and elevated FSH levels seems to be a relatively good indicator for the presence of organic disorders of the testis.

[Determination of plasma homocysteine in oligospermia and/or asthenospermia patients]

OBJECTIVE

To detect the level of fasting plasma homocysteine (Hcy) in patients with oligospermia and/or asthenospermia and to investigate its clinical significance.

METHODS

Semen quality analyses and fasting plasma Hcy determination were performed for 86 infertility patients (21 with oligospermia, 32 with asthenospermia and 33 with oligo-asthenospermia) and 19 normal fertile volunteers. The results were compared.

RESULTS

The level of plasma Hcy was significantly higher in the infertility patients than in the normal controls (P < 0.05) and negatively correlated with sperm concentration (r = -0.433, P < 0.01), the percentage of grade a sperm (r = -0.303, P < 0.05) and the percentage of grade a+b sperm (r = -0.339, P < 0.01).

CONCLUSION

The increased level of human plasma Hcy directly or indirectly affects spermatogenesis and correlates negatively with oligospermia and/or asthenospermia.

The role of manix in the management of idiopathic oligospermia. A pilot study at the Lagos University Teaching Hospital

OBJECTIVES

To assess the usefulness of Manix in the management of men with idiopathic oligospermia.

PATIENTS AND METHODS

The study involved 55 infertile men with idiopathic oligospermia. Thirty-five patients were administered oral 600 mg of manix for 13 weeks and 20 were put on oral 1000 IU of vitamin E for 13 weeks. Semen analysis and the sex hormone profiles were done as baseline and then repeated at 3 and 6 months.

RESULTS

There were statistically significant improvements in semen parameters in the patients on Manix . No improvement was noted in the other group on vit E. There was however no significant difference in pregnancy rates in the two groups.

CONCLUSION

Manix may play a role in the management of patients with idiopathic olligospermia. However, large scale double blind controlled trials are needed to confirm the findings in this preliminary study.

Serum leptin correlates in infertile oligozoospermic males

Leptin is an adipocyte-secreted protein that participates in the regulation of energy homeostasis. Eighty men were investigated; fertile normozoospermia as a control (n = 30) and infertile oligozoospermia (n = 50). The patients underwent estimation of body weight (kg), height (cm), calculation of body mass index (BMI), semen analysis, serum leptin and testosterone hormones. Mean body weight was significantly higher in infertile oligozoospermia compared with controls. Mean height, BMI and serum testosterone levels showed nonsignificant differences between the two groups. Infertile oligozoospermia had significantly higher mean serum leptin level than controls (mean +/- SD; 6.88 +/- 8.65, 16.3 +/- 13.98 ng ml(-1), P < 0.01). Serum leptin demonstrated significant positive correlation with age, body weight, BMI and significant inverse correlation with serum testosterone. It had nonsignificant correlation with the height and sperm concentration. These results are suggestive of a link between the adipocyte derived hormone, leptin and male reproduction.

[Facilitation of Shengjingbao to spermatogenesis in oligospermia mouse models and its action mechanisms]

OBJECTIVE

To investigate the effects of Shengjingbao on spermatogenesis in the mouse model of oligospermia and its action mechanisms.

METHODS

Sixty male mice were randomly divided into 4 groups, Shengjingbao (Group 1), Vitamin E (Group 2), blank model control (Group 3) and normal blank control (Group 4). The first three groups were treated by celiac injection of cyclophosphamide for 5 successive days to make models, followed by intragastric administration of Shengjingbao and Vitamin E to Group I and 2, respectively, for 36 days. And then all the mice were sacrificed. The serum testosterone (T) level was determined by radioimmunology, and a suspension was made from the testis and epididymis of one side for sperm analysis, while the testis of the other side was sliced up and stained by HE method and TUNEL technique to detect the count of Leydig cells, the layers of spermatogenic epithelia and the apoptosis of spermatogenic cells.

RESULTS

Compared with Group 3, the serum T level, the layers of spermatogenic epithelia and the count of Leydig cells were obviously improved and even exceeded those in Group 2. The positive expression rate of spermatogenic cell apoptosis in Group 1 was evidently lower than Group 2 and 3. The above differences were statistically significant (P < 0.01 or P < 0.05), but no significant difference was noted between Group 1 and 4.

CONCLUSION

Shengjingbao can significantly increase the count of Leydig cells, elevate the T level that influences the layers of spermatogenic epithelia, and thus enhance spermatogenesis. The action mechanisms of Shengjingbao may lie in its capacity of inhibiting the apoptosis of spermatogenic cells, increasing the layers of spermatogenic epithelia and facilitating spermatogenesis. T may play a role in inhibiting the apoptosis of spermatogenic cells.

Frequency of Y chromosome microdeletions and chromosomal abnormalities in infertile Thai men with oligozoospermia and azoospermia

AIM

To investigate the possible causes of oligozoospermia and azoospermia in infertile Thai men, and to find the frequencies of Y chromosome microdeletions and cytogenetic abnormalities in this group.

METHODS

From June 2003 to November 2005, 50 azoospermic and 80 oligozoospermic men were enrolled in the study. A detailed history was taken for each man, followed by general and genital examinations. Y chromosome microdeletions were detected by multiplex polymerase chain reaction (PCR) using 11 gene-specific primers that covered all three regions of the azoospermic factor (AZFa, AZFb and AZFc). Fifty men with normal semen analysis were also studied. Karyotyping was done with the standard G- and Q-banding. Serum concentrations of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL) and testosterone were measured by electrochemiluminescence immunoassays (ECLIA).

RESULTS

Azoospermia and oligozoospermia could be explained by previous orchitis in 22.3%, former bilateral cryptorchidism in 19.2%, abnormal karyotypes in 4.6% and Y chromosome microdeletions in 3.8% of the subjects. The most frequent deletions were in the AZFc region (50%), followed by AZFb (33%) and AZFbc (17%). No significant difference was detected in hormonal profiles of infertile men, with or without microdeletions.

CONCLUSION

The frequencies of Y chromosome microdeletions and cytogenetic abnormalities in oligozoospermic and azoospermic Thai men are comparable with similarly infertile men from other Asian and Western countries.

[Change of pulsatile release and luteinizing hormone response to naloxone related to testicle damage]

OBJECTIVE

To compare the pulsatile release of LH, the tone of endogenous opioids and the mass of LH secreted after a naloxone infusion in healthy subjects and patients with normogonadotropic oligospermia (NO) in a model of progressive testicular damage.

PATIENTS AND METHODS

Pulsatile secretion of LH was analyzed in a period of 8 hours in a group of healthy subjects (group 3, n=5), in patients with NO and FSH/LH ratio <1.6 (group 1, n=5) and in patients with NO and FSH/LH ratio >1.6 (group 2, n=5). The area under the curve of LH response after naloxone infusion was also calculated.

RESULTS

Free serum testosterone concentration was lower (p < 0.01) and estradiol concentration higher in patients with NO than control subjects (1 vs. 3: p = 0.01; 2 vs. 3: p = 0.001). Frequency of pulses in group 1 was 3.33 +/- 0.57/8 h, in group 2: 4 +/- 1/8 h; and in group 3: 2.66 - 0.57/8 h (2 vs. 3 p < 0.01; 2 vs. 1 p = 0.05). The area under the curve after naloxone infusion was 19,300.44 +/- 11,403.31 in group 1, 5696.09 +/- 1753.44 in group 2; and 3080.97 +/- 1159.78 in group 3 (1 vs. 3 Anova p = 0.01).

CONCLUSIONS

The data indicate that patients with NO have a subclinical pantesticular failure and that the opioid tone is increased at the initial phase of testicular dysfunction, but it decreases at more advanced stages of testicular damage.

Elevated follicle-stimulating hormone levels and the chances for azoospermic men to become fathers after retrieval of elongated spermatids from cryopreserved testicular tissue

OBJECTIVE

To assess individual chances for a live-born child in azoospermic men by performance of testicular sperm extraction (TESE) followed by intracytoplasmatic sperm injection (ICSI).

DESIGN

A retrospective cohort study.

SETTING

An academic fertility care center and research unit.

PATIENT(S)

Two hundred three couples who wished to have a child; all men had azoospermia.

INTERVENTION(S)

All men were operated for TESE; 112 men were found to have elongated spermatids (ES), and 209 ICSI cycles were performed in these men using cryopreserved tissue.

MAIN OUTCOME MEASURE(S)

Predictors for the chances to obtain live sperm and for probabilities of fertilization, clinical pregnancies, and live births.

RESULT(S)

Testicular volume, FSH, and inhibin B levels were predictors for the presence of ES. Intracytoplasmic sperm injection resulted in 23 pregnancies, leading to 20 live births. Despite the presence of ES and performance of ICSI in cases of FSH levels >or=20 IU/L, no pregnancy resulted in these men (n = 21). Receiver operating characteristics revealed FSH levels of >or=20 IU/L as cutoff for treatment success. The number of testicular tubuli containing ES served as a predictor for clinical pregnancy as well as for live birth. Cigarette smoking by the male partner exerted a significant negative influence on treatment success.

CONCLUSION(S)

The degree of completely maintained spermatogenesis within the biopsy appears to reflect intrinsic abilities of spermatozoa to induce normal embryo development. Charts based on regression models are presented for counseling patients before TESE; these explain chances of finding ES and probability of successful ICSI. Obtaining offspring is unlikely in cases of azoospermia and of FSH levels of >or=20 IU/L.

Serum anti-Müllerian hormone levels do not predict the efficiency of testicular sperm retrieval in men with non-obstructive azoospermia

BACKGROUND

We aimed to determine whether serum concentrations of anti-Müllerian hormone (AMH) can be used as a tool for prediction of the efficacy of sperm retrieval.

METHODS

This was a prospective cohort observational study. AMH levels were determined in 47 men presenting for infertility evaluation. Group 1 consisted of 24 infertile patients diagnosed with non-obstructive azoospermia. Group 1 was further divided into two subgroups. The patients with spermatozoa in their testicular samples constituted group 1a (n = 13), while the patients with absence of spermatozoa constituted group 1b (n = 11). Twenty-three normozoospermic fertile men constituted group 2. Serum AMH was measured before obtaining testicular specimens.

RESULTS

Testicular spermatozoa were recovered in 13 out of the 24 patients (54%). Demographic characteristics of the three groups were similar. The difference between serum AMH levels among the three groups did not reach statistical significance.

CONCLUSIONS

We speculated that although AMH is secreted predominantly into the seminiferous tubules, studying serum samples might be more advantageous than seminal plasma because the presence of seminal proteases could influence AMH levels in the latter. However, our results did not demonstrate differences in serum concentrations of AMH between the studied groups. Studies with extended patient populations focusing on seminal plasma concentrations of AMH are warranted.

[Chromosomal disorders in the background of azoospermia]

INTRODUCTION

Nowadays more and more couples face the fact that they cannot have babies in spite of many years of trying. The male factor can be identified in about half of these cases.

AIM

The aim of this study was to analyse chromosomal alterations in patients with azoospermia. These patients may be candidates for testicular sperm retrieval and intracytoplasmatic sperm injection.

MATERIALS AND METHODS

Preoperative evaluation included routine andrological investigation with 2 semen analysis, ultrasound, hormonal and genetic examination. Traditional histological examination and embryological diagnostic of tissue samples was performed. Cryopreservation of retrieved testicular tissue was also done. Between January 2001 and June 2005 73 biopsies were performed in 71 patients for testicular sperm extraction. In order to obtain an exact diagnosis, the traditional cytogenetic methods and fluorescence in situ hybridization analyses were performed in combination with molecular genetic techniques. Patients were offered to participate in the assisted reproduction programme on the base of their genetic results.

RESULTS

In this study, the most characteristic cases were numerical deviations, such as 47,XXY (2 cases), mosaic 47,XXY/49,XXXXY (1 case), 47,XYY (1 case) and mosaic 46,XY/45,X (1 case) karyotypes. Non-obstructive azoospermia was diagnosed in 53 patients (79%).

CONCLUSIONS

Authors emphasised the importance of cyto- and molecular examinations in cases of genetical disorders. The results provide a chance for patients to be spared from long-drawn moreover psychological burdening examinations. In addition the costs of different clinical intervention could be saved too.

Induction of spermatogenesis in azoospermic men after varicocelectomy repair: an update

OBJECTIVE

To assess the treatment outcome after varicocele repair in azoospermic men and to correlate this outcome with the testicular histology patterns.

DESIGN

Prospective study.

SETTING

Academic medical centers.

PATIENT(S)

Medical records of 27 azoospermic men, who underwent testis biopsy and microsurgical repair of clinical varicocele between July 1999 and May 2004, were reviewed.

INTERVENTION(S)

Twenty-seven azoospermic men underwent testis biopsy and microsurgical repair of clinical varicocele. All patients had at least two semen analyses showing azoospermia taken before the surgery and two semen analyses postoperatively.

MAIN OUTCOME MEASURE(S)

Semen analysis after varicocelectomy.

RESULT(S)

Hypospermatogenesis was identified in 9, maturation arrest in 8, and germ cell aplasia in 10 men. Induction of spermatogenesis was achieved in nine men (33.3%). Of these, four had germ cell aplasia, three had maturation arrest, and two had hypospermatogenesis. The improvement in sperm concentration and motility ranged from 1.2 x 10(6)/mL to 8.9 x 10(6)/mL, and from 24% to 75.7%, respectively. Of these nine patients with improvement in semen quality, five relapsed into azoospermia 6 months after the recovery of spermatogenesis (four germ cell aplasia and one maturation arrest). One patient with maturation arrest established pregnancy.

CONCLUSION(S)

Azoospermic patients may have an improvement in semen quality after varicocelectomy. Semen samples may be cryopreserved after an initial improvement after varicocelectomy.

Long term effects of micro-surgical testicular sperm extraction on androgen status in patients with non obstructive azoospermia

BACKGROUND

The aim of our study was to review the results of microsurgically performed testicular sperm extraction (TESE) and to evaluate its possible long term effects on serum testosterone (T).

METHODS

We operated on 48 men (35 +/- 8 years) with non-obstructive azoospermia (NOA). If no spermatozoa were found following a micro epididymal sperm extraction (Silber et al., 1994) and testicular biopsy, testicular microdissection was performed or multiple microsurgical testicular biopsies were taken. The mean follow-up of the serum T was 2.4 +/- 1.1 years.

RESULTS

Sperm was retrieved in 17/48 (35%) of the men. The per couple take home baby rate if sperm was retrieved was 4/17 (24%). Serum T decreased significantly at follow-up (p < 0.05) and 5/31 (16%) de novo androgen deficiencies developed

CONCLUSION

In patients with non-obstructive azoospermia in whom no spermatozoa were found following a micro epididymal sperm aspiration and a simple testicular biopsy, we were able to retrieve spermatozoa in 35% of the men. The take home baby rate was 24% among couples with spermatozoa present upon TESE. De novo androgen deficiency occurred in 16% of the male patients following TESE indicating that, in men with NOA, long term hormonal follow up is recommended after TESE.

SCREENING OF FSH RECEPTOR GENE MUTATION (C566T) IN AZOOSPERMIC MEN IN JAPAN

To study the genetic mutation, which could cause problems in spermatogenesis, we screened the point mutations of the FSH receptor gene (C566T) in idiopathic azoospermic men in Japan. We performed mutational analysis of the FSH receptor in 54 Japanese patients diagnosed for azoospermia with Sertoli cell-only (SCO) syndrome (n = 33), hypospermatogenesis (n = 11) and maturation arrest (n = 10). For mutation screening of the FSH receptor, polymerase chain reaction (PCR) amplification from genomic DNA with flanking intronic primers were used. On BsmI digestion, all patients demonstrated homozygous, normal exon 7 alleles with 51 and 27 bp fragments. The absence of any 78 bp fragments demonstrated that no heterozygous or homozygous mutant alleles were present in any patients. None of the 54 patients showed a C566T FSH receptor mutation. We could not confirm that the genomic mutation of the FSH receptor (C566T) is a common cause in Japanese azoospermic patients.

[Relationship between pathological alterations of spermatogenic impairment and serum inhibin B concentration in patients with azoospermia]

OBJECTIVE

To investigate the relationship between pathological alterations of spermatogenic impairment in seminiferous tubules and serum inhibin B concentration in patients with azoospermia and to verify the significance of INH B in evaluating spermatogenesis.

METHODS

Eighty-three cases of azoospermia underwent testicular biopsy for the purpose of diagnosis. In accordance with the pathological alterations of spermatogenesis in seminiferous tubules, the samples were divided into four groups: Sertoli cell-only syndrome (n = 21); hypospermatogenesis (n = 20); maturation arrest (n = 24) and almost normal spermatogenesis (n = 18). Serum INHB and FSH, LH, T concentrations were tested before testicular biopsy for each patient respectively.

RESULTS

The INHB levels were (20. 85 +/- 18.78) pg/ml, (67.25 +/- 40.98) pg/ml, (73.63 +/- 25.54) pg/ml and (149.48 +/- 27.92) pg/ml in the above four groups, respectively. There was no significant statistical difference in the level of serum INH B between maturation arrest and hypospermatogenesis groups (P > 0.05), and there was a very significant difference in almost normal spermatogenesis group and the other three groups, respectively (P < 0.001). There was no significant difference in the concentration of serum FSH when maturation arrest group compared with spermatogenesis group (P > 0.05), whereas between the other two groups and between each of them and maturation arrest or almost normal spermatogenesis there was a very significant difference in the level of serum FSH (P < 0.05); The concentrations of LH and T were not significantly different among the four groups (P > 0.05).

CONCLUSION

Serum INHB concentration was decreased when spermatogenesis got impaired. It dropped the most markedly in Sertoli cell-only syndrome group. INH B reflects directly the spermatogenic function in seminiferous tubules of the testis. Therefore, it could be considered valuable for spermatogenesis and potential fertility in patients with azoospermia.

Oral clonidine advances spermatogenesis in oligozoospermic patients with spermatogenetic maturation arrest

BACKGROUND

Growth hormone (GH) plays an important role in the pubertal development of males and females, and influences the male reproductive function after puberty. The purpose of this study was to investigate the cause of GH deficiency in infertile men with spermatogenetic maturation arrest using the clonidine loading test (GH stimulation test). Based on the results of the loading test, we tried to con fi rm whether clonidine might be usable as a male infertility remedy.

METHODS

We studied 75 infertile men (55 oligozoospermic and 20 azoospermic men) and 25 normal fertile volunteers. We used the oral clonidine (0.15 mg/m2) loading test to evaluate the GH secretory reserve. Histological diagnoses were performed using testicular biopsy and testicular sperm extraction specimens.

RESULTS

The most important finding was that the clonidine loading test caused a good response in 41 out of 55 (74.6%) patients with oligozoospermia. We treated these 41 good-response patients with oral clonidine, and the sperm count improved in 34 (82.9%) cases, increasing to 12-79 million/mL. Spontaneous pregnancy was subsequently achieved by 10 (24.4%) couples.

CONCLUSIONS

These findings also suggest that GH is necessary for spermatogenesis, at least for the process of spermatozoa maturation. Oral clonidine therapy improved the sperm count in patients who showed an excessive response to the clonidine loading test.

Experimental testicular torsion: reperfusion blood flow and subsequent testicular venous plasma testosterone concentrations

OBJECTIVES

To examine the effect of torsion on subsequent testicular venous plasma testosterone concentrations (TVT) and to determine the relationship between the TVT values 30 days after torsion repair and testicular reperfusion immediately after torsion repair, because testicular torsion followed by repair induces an ischemia/reperfusion injury of the testis.

METHODS

Adult male rats were subjected to 1 hour of 720 degrees testicular torsion, a time and degree of torsion that has been shown to cause severe impairment of spermatogenesis. Testicular microvascular perfusion before torsion, during torsion, and 5 minutes after torsion repair was determined by laser Doppler flowmetry. The animals were evaluated 3 days and 30 days later for microvascular perfusion and TVT.

RESULTS

Experimental torsion significantly reduced testicular vascular perfusion. Five minutes after torsion repair, the mean flow values had returned to approximately 70% of the pretorsion values. Testicular torsion significantly reduced TVT at both 3 and 30 days after torsion repair. TVT 30 days after torsion repair was significantly, but inversely, related to reperfusion values immediately after torsion repair.

CONCLUSIONS

These results demonstrate that the minimal duration and degree of torsion known to cause loss of spermatogenesis in the rat also causes a significant reduction in testicular androgen production in the long term. This effect was inversely related to the reperfusion values immediately after torsion repair. This suggests that reperfusion/oxidative stress may play a role in Leydig cell dysfunction, as well as by acting directly in germ cell apoptosis.

Serum inhibin B and follicle-stimulating hormone levels as markers in the evaluation of azoospermic men: a comparison

Inhibin B is a glycoprotein hormone produced mainly by Sertoli cells of the testes in the adult male. It selectively suppresses the secretion of pituitary follicle-stimulating hormone (FSH) and has local paracrine actions in the testes. Its measurement is useful for investigating the role of inhibin B in male gonadal dysfunction. The objective of this study was to investigate the efficacy of serum inhibin B in men with nonobstructive azoospermia in comparison with FSH. Serum concentration of FSH was measured using microparticle enzyme immunoassay, inhibin B by specific solid phase sandwich enzyme-linked immunosorbent assay in men with nonobstructive azoospermia (n = 46) and control fertile men (n = 5). Mean inhibin B and FSH level was 104.6 pg ml(-1) and 4.0 mIU ml(-1) in control men whereas the value for nonobstructive azoospermic men was 17.06 pg ml(-1) and 31.1 mIU ml(-1) respectively. Inhibin B and FSH levels were significantly different in azoospermia than controls (P < 0.0001). There were six cases of nonobstructive azoospermia with normal inhibin B. Testicular histology did not find any evidence of spermatogenesis in three cases with normal inhibin B. This demonstrated that inhibin B was not a superior predictor for testicular function in our study.

Differentiating between primary and secondary Sertoli-cell-only syndrome by histologic and hormonal parameters

The contribution of histologic differentiation between primary and secondary Sertoli-cell-only (SCO) syndrome in azoospermic men was evaluated. No correlation was found between the presence of sperm cells in the testis and the histologic findings or inhibin B or FSH levels, suggesting a low prognostic value for this differentiation.

A prospective randomized study comparing gonadotropin-releasing hormone agonists or gonadotropin-releasing hormone antagonists in couples with unexplained infertility and/or mild oligozoospermia

OBJECTIVE

To compare the efficacy of GnRH antagonist vs. GnRH agonist administration for controlled ovarian hyperstimulation (COH) in assisted reproduction.

DESIGN

A prospective, randomized trial.

SETTING

Clinical research unit at a tertiary care medical center.

PATIENT(S)

Sixty-five patients with unexplained infertility or mild male subfertility undergoing COH for IUI.

INTERVENTION(S)

Twenty-nine women (group A) were randomized to receive 600 microg of busereline acetate per day starting in the midluteal phase of the cycle (long protocol), whereas 36 women (group B) were treated with 0.25 mg/d of the GnRH antagonist Cetrorelix starting from day 6 of the cycle. The starting dose of recombinant FSH was 150 IU in women of both groups. Insemination was performed 34 hours after hCG injection.

MAIN OUTCOME MEASURE(S)

Clinical and successful ongoing pregnancy rate (PR), measurements of serum FSH, LH, E2, and P, number of recruited follicles, duration of stimulation period, and amount of gonadotropins used.

RESULT(S)

Women in group A required significantly more days of treatment (median: 12.0 vs. 9.0) and significantly more total units of recombinant FSH (median 1,800 vs. 1,550) as compared with the corresponding values of the antagonist group (group B). Serum FSH, LH, E2, and P were significantly higher on the antagonist group on days 2 and 6 of stimulation. However, these differences regress until the day of hCG administration.

CONCLUSION(S)

The GnRH antagonists have facilitated short and simple treatment, and are particularly attractive for administration in women undergoing COH, achieving comparable PR with the long protocol regimen.

Selenium status of idiopathic infertile Nigerian males

Selenium concentration in the sera and seminal plasma of 60 infertile males (40 oligospermia and 20 azoospermia) and 40 males with proven evidence of fertility (normospermia; control group) were estimated using atomic absorption spectrophotometry. Results were correlated with spermatogram and hormonal levels in order to determine their relationship and significance in male infertility. The mean serum concentrations of selenium was found to be significantly increased in oligospermic compared to azoospermic subjects and controls (p < 0.01), whereas the seminal plasma level was significantly higher in azoospermic compared to oligospermic subjects and controls (p < 0.001). Thus, the ratio of serum selenium to seminal plasma selenium was 1: 1 in controls, 4: 1 in oligospermia, and 1: 2 in azoospermic subject.A significant inverse correlation was observed between serum selenium level and sperm count (p < 0.01). Similarly, seminal plasma selenium correlated with spermatozoa motility, viability, and morphology. Serum selenium level shows positive correlation with the serum testosterone level (p < 0.01). In conclusion, there appears to be a physiological balance in the distribution of selenium in serum and seminal plasma compartment of control males. A disturbance in this balance has a significant influence on spermatogenesis. Selenium appears to have a positive influence on Leydig cells, thus influencing the secretion of testosterone.

High frequency of Y chromosome microdeletions in idiopathic azoospermic men with high follicle-stimulating hormone levels

Y chromosome microdeletions were detected in 33.3% (6 out of 18) of idiopathic azoospermic patients with high serum follicle-stimulating hormone (FSH) levels in the present study. The results suggest that it may be necessary to detect microdeletions in patients with azoospermia, especially for those with high serum FSH levels, before assisted reproductive technology (ART) is provided to them.

Messenger RNA transcripts of the meiotic regulator BOULE in the testis of azoospermic men and their application in predicting the success of sperm retrieval

BACKGROUND

Testicular sperm retrieval can lead to paternity for azoospermic patients with spermatogenic failure. The human BOULE gene, a meiotic regulator of germ cells, is a gene whose altered expression may be associated with sterility. We determined the levels of BOULE transcripts in the testes of azoospermic patients, and evaluated the relationship between BOULE transcript levels and patients' testicular phenotypes, clinical parameters and sperm retrieval results.

METHODS AND RESULTS

BOULE transcript levels in the testes of 41 azoospermic patients were examined by quantitative competitive-reverse transcription-polymerase chain reaction. A significant decrease in BOULE transcript levels was detected in patients with spermatogenic failure, and BOULE transcript levels progressively decreased with increasing severity of testicular failure. BOULE transcript levels did not correlate with the serum hormone parameters measured. Significantly higher BOULE transcript levels were detected in 19 patients with successful sperm retrieval than in 12 patients with failed sperm retrieval. When using a cut-off value of 0.5 for BOULE transcript ratio to predict the success of sperm retrieval, both the sensitivity and specificity value were 100%.

CONCLUSIONS

We suggest the BOULE transcript plays an important role in human spermatogenesis and that the levels may predict the presence of testicular sperm in patients with spermatogenic failure.

Differential regulation of inhibin subunits by germ cells in human testes

Inhibin B is comprised of two dissimilar disulfide-linked subunits, termed alpha and betaB, and is physiologically more important than inhibin A in the male. The aim of this study was to investigate testicular expression of inhibin subtypes in infertile men to uncover any interaction between Sertoli cells and germ cells. Ten azoospermic patients with Sertoli cell only syndrome (SCO) and 39 oligozoospermic men were included in this study. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone concentrations were determined by chemiluminescence assays. The serum concentrations of inhibin B were measured by enzyme-linked immunosorbent assay. Immunohistochemical staining for the alpha-subunit, betaA-subunit, and betaB-subunit of inhibin were performed on testicular biopsy specimens. The results were that serum inhibin B was undetectable in azoospermic men with SCO, while it was 133.8 +/- 82.0 pg/ml in oligozoospermic men. There was little expression of betaA in the testes of any patient. Expression of inhibin alpha and betaB was observed in Sertoli cells. The percentage of Sertoli cells expressing inhibin alpha was similar in azoospermic patients with SCO (55.3% +/- 20.6%) and in oligozoospermic patients (42.8% +/- 30.4%). In contrast, expression of betaB in Sertoli cells of azoospermic patients (24.9% +/- 16.8%) was lower than in oligozoospermic men (43.4% +/- 25.5%: P = 0.0308). There are no significant correlations between testicular expression of inhibin betaB and the serum inhibin B concentrations. The expression of inhibin betaB by Sertoli cells is dependent on the coexistence of spermatogenic activity within these seminiferous tubules, explaining why the level of inhibin B is low in patients with SCO.

Clinico-hormonal correlation of oligospermic patients in the below sea level environment (Jordan Valley)

A correlation between serum levels of luteinizing hormone (LH), total testosterone (T), free T and sex-hormone binding globulin (SHBG) in normospermic and in oligospermic male people was done. This study was designed to measure serum levels of these hormones and of SHBG in people living at different altitude environments relative to sea level: at 209-408 meters below (the Jordan Valley, JV) and at 620 meters above (Irbid city, IC). In addition, a clinical awareness study of oligospermia was done in the North of Jordan (IC). Seminal analysis in 287 male people (age range, 18 to 40 years old) during the period between 12/6/1999 and 12/2/2002 showed an oligospermia of 31.4%. Serum levels of LH, total T, free T and SHBG in normospermic subjects in IC were similar to those in normospermic of the JV (3.4 +/- 1.2 vs. 4.0 +/- 1.7 MIU/ml, 19.9 +/- 4.0 vs. 20.4 +/- 5.6 ng/ml, 53.9 +/- 15.6 vs. 47.9 +/- 10.7 pg/ml, 19.5 +/- 3.2 vs. 18.6 +/- 2.16 nmol/l, respectively). Oligospermia was associated with increase in total T at both IC (27.5 +/- 4.6 vs. 19.9 +/- 4.0 ng/ml) and the JV (30.7 +/- 3.4 vs. 20.5 +/- 5.6). The higher serum level of total T in oligospermic people in both IC and the JV was associated with higher levels of SHBG compared to those levels in normospermic subjects. On the other hand, oligospermic subjects have lower serum level of free T than in normospermic males (41.5 +/- 10.0 vs. 53.9 +/- 15.6) only in IC, while in the JV, serum free T level was similar (46.5 +/- 6.1 vs. 47.9 +/- 10.7). Taken together data for both locations, IC and the JV, suggest a clear correlation between total T and SHBG levels in both groups' normospermic and oligospermic subjects.

Clinical and hormonal findings in testicular maturation arrest

OBJECTIVE

To clarify the pathophysiology of maturation arrest (MA), one of the most important causes of male infertility, by examining testicular morphology and biophysical and endocrine profiles of azoospermic patients with MA.

PATIENTS AND METHODS

Thirty azoospermic men were assessed; 10 were found to have Sertoli-cell only syndrome or chromosomal abnormalities, and 20 to have MA on biopsy. The second group had their clinical variables and findings analysed retrospectively after the diagnosis of MA (mean age 32.1 years, sd 5.2). Johnsen's score, serum hormone levels (follicle stimulating hormone, FSH, luteinizing hormone, LH, testosterone, prolactin and oestradiol), testicular volume, and the diameter of the seminiferous tubules, were evaluated. Patients were categorized into groups according to Johnsen score, i.e. group 1 (<4), group 2 (> or =4 and <6) or group 3 (> or =6). The clinical variables were compared in each group.

RESULTS

Hormone levels in almost all patients were in the normal range. FSH was related to the stage of MA; the difference in FSH between groups 1 and 3 was significant (P = 0.006). Serum levels of LH, testosterone, prolactin or oestradiol were similar in all groups. The diameter of the seminiferous tubules was less in group 1 than in group 3 (r = 0.881, P < 0.001) and there was an inverse and linear correlation between the FSH concentration and the diameter of the seminiferous tubules (r = -0.661, P = 0.0028).

CONCLUSIONS

FSH is the most useful variable for evaluating the severity of MA, even when it is within the normal range. The finding that gonadal hormone concentrations are normal in patients with MA suggests that an abnormality other than a disturbance in the hypothalamo-pituitary-testicular axis is responsible for MA.

[Inhibin B, predictive factor for testicular sperm recovery?]

Serum inhibin B is a glycoprotein of gonadal origin secreted by the sertoli cells and its secretion is regulated by interaction with the germ cells. Its role as a marker of spermatogenesis is clearly established. Therefore, its role as predictor for finding sperm by surgical testicular sperm retrieval in non-obstructive azoospermia was evaluated as in these patients sperm will only be recovered in half the cases. Our results together with a review of the reports published so far, show that although inhibin B is more accurate in predicting the result of sperm recovery, it cannot predict the outcome of a testicular sperm recovery in patients with non-obstructive azoospermia.

[Detection of free testosterone in the serum and semen of idiopathic oligospermia patients and its significance]

OBJECTIVE

To detect free testosterone (FT) in the serum and semen of patients with idiopathic oligospermia, and further analyze the relationship between FT and idiopathic oligospermia.

METHODS

Blood samples were collected from the males of a normal control group (n = 44) and an idiopathic oligospermia group (n = 44) at 8:00-10:00 a.m.. Semen samples were collected from the males of a normal control group (n = 30) and an idiopathic oligospermia group (n = 37) at the same time. Sperm density was detected by routine semen analysis, and FT in the serum and semen was detected by RIA.

RESULTS

There was no significant difference in the serum concentrations of FT between the groups of normal control [(97.50 +/- 46.96) pmol/L] and idiopathic oligospermia [(94.88 +/- 42.04) pmol/L], P > 0.5. But the difference was significant in the semen concentrations of FT between the groups of normal control [(2.01 +/- 0.32) pmol/L] and idiopathic oligospermia [(0.52 +/- 0.44) pmol/L], P < 0.01.

CONCLUSION

Measurement of semen FT concentration could early reflect the function of the testis, which contributes to the early diagnosis and treatment of idiopathic oligospermia.

Role of varicocelectomy in men with nonobstructive azoospermia

OBJECTIVE

To evaluate the benefits of varicocelectomy in men with nonobstructive azoospermia.

DESIGN

Retrospective review of effect of prior varicocelectomy on sperm retrieval rates in men with nonobstructive azoospermia. Chart review of men with nonobstructive azoospermia who underwent microsurgical varicocelectomy to determine the effect of the procedure on the need for testicular sperm extraction (TESE).

SETTING

Tertiary, university-based referral center.

PATIENT(S)

Men with clinical varicoceles and nonobstructive azoospermia.

INTERVENTION(S)

Microsurgical varicocelectomy, TESE.

MAIN OUTCOME MEASURE(S)

Return of sperm to the ejaculate and need for TESE after varicocele repair, ability to find sperm using microdissection TESE.

RESULT(S)

Of 31 men who underwent varicocele repair at one institution for documented nonobstructive azoospermia, 7/31 (22%) had sperm reported on at least one semen analysis postoperatively. However, only 3/31 (9.6%) men after varicocele repair had adequate motile sperm in the ejaculate for ICSI, without TESE. Sperm retrieval rates for men with varicoceles were not affected by a history of prior varicocelectomy.

CONCLUSION(S)

Men with clinical varicoceles that are associated with nonobstructive azoospermia will rarely have adequate sperm in the ejaculate after varicocele repair to avoid TESE. A history of prior varicocele repair does not appear to affect the chance of sperm retrieval by TESE for men with clinical varicoceles and nonobstructive azoospermia. The benefits of varicocelectomy in men with nonobstructive azoospermia may be less than previously reported.

Molecular and cytogenetic characterization of two azoospermic patients with X-autosome translocation

PURPOSE

To report two azoospermic patients with reciprocal X-autosome translocations.

METHODS

Cytogenetic analysis utilizing GTG-banding and Yq microdeletions shown by polymerase chain reaction (PCR) with 12 sequence-tagged site (STS) markers for Y chromosome microdeletions.

RESULTS

Cytogenetic analysis showed one man with 46,Y,t(X;19)(q22;q13.3) and the other with 46,Y,t(X;8)(p22;q11). Neither had any Yq microdeletions shown. The patient with 46,Y, t(X;8)(p22;q11) showed a slightly lower than normal testosterone level. By NCBI-Blast search, we found four testis-specific genes, t-complex-associated-testis-expressed 1-like (TCTE1L), Ferritin, heavy polypeptide-like 17 (FTHL17), Testis expressed sequence 13A (TEX13A), and Testis expressed sequence 13B (TEX13B) located near breakpoints on X chromosome. FTHL17, TEX13A, and TEX13B are spermatogonially-expressed, germ-cell-specific genes.

CONCLUSION

This is the first clinical report of azoospermia with reciprocal X-autosome translocations on Xp22 and q22. These translocations on Xp22 and q22 may be direct genetic risk factors for azoospermia.

Fertility after high-dose chemotherapy for testicular cancer

OBJECTIVES

To describe long-term gonadal function after high-dose chemotherapy (HDC). HDC for testicular cancer was recently developed. The evaluation of testicular function after chemotherapy for testicular cancer is an important part of overall care, especially in young patients.

METHODS

Between 1994 and 2001, 27 patients underwent HDC (1250 mg/m2 carboplatin, 1500 mg/m2 etoposide, and 7.5 g/m2 ifosfamide) at Kobe University Hospital. Information on gonadal function during follow-up was available for 10 of these patients. The mean patient age +/- SD at treatment was 32.2 +/- 8.4 years. The relationships among age at treatment, semen analysis, serum hormone levels (follicle-stimulating hormone, luteinizing hormone, testosterone, prolactin, and estradiol), cumulative dose of cisplatin and carboplatin, and length of follow-up were determined.

RESULTS

Spermatogenesis recovered after cessation of HDC in 5 of 10 patients. Semen analysis in these patients showed the mean sperm concentration and motility at 42.4 +/- 10.4 million/mL and 67.2% +/- 17.0%, respectively. The patients were divided into azoospermic and nonazoospermic groups. The age of the nonazoospermic and azoospermic patients was 28.2 +/- 8.7 and 36.2 +/- 6.5 years, respectively. Follicle-stimulating hormone levels in the nonazoospermic group (11.7 +/- 3.4 mIU/mL) were significantly lower than in the azoospermic group (32.8 +/- 14.4 mIU/mL; P = 0.0472). No other statistically significant difference was observed in the other hormone levels or the cumulative dose of cisplatin and carboplatin between the azoospermic and nonazoospermic groups.

CONCLUSIONS

Spermatogenesis recovers after HDC in some patients. Patients should be informed that they may or may not be fertile after HDC.