庚酸睾酮诱导的无及少精子症者生殖激素和精子功能指标变化的观察

本文报道两组接受庚酸睾酮(TE200mg/周16个月)正常育龄男子的精液分析、血清生殖激素、精子特殊功能的动态变化。结果:第一组(8名)血清 FSH、LH 和 T 给药前平均自身对照值分别为2.7、6.2IU/L和16.5nmol/L,注射后3、6、9、12个月 FSH 下降了63％;LH 下降了69.4～72.6％;T 升高176％～198％。平均经117.5±2.87天治疗后全部受试者均达到无精症,连续给药1年的女方无妊娠。3种激素在停药3个月后恢复到给药前水平,精子计数10～12个月恢复到正常范围。第二组(16名)在给药第一个月后精子计数开始下降的同时3种精子特殊功能均有显著下降,而同期精子活动率(a+b)却无显著改变。我们的结果表明:(1)同一剂量和疗程的 TE 导致中国人的无精于发生率远高于白种人,(2)这一激素方法是有效、可靠和可逆的男性避孕措施,(3)TE 的避孕机理除抑制精子发生外,似还有精子功能的早期损伤的抗生育效应。这一机理不同于 GnRH 拮抗剂(Nal-glu),后者仅降低精子计数和活动率,而无精子多元运动速度指标的任何改变。     

Dynamic study of serum gonadotrophin and testosterone levels in gossypol-treated men Long term follow-up study of 60 cases

The endocrine effects of gossypol were studied in 26 men for 52 months before, during and after treatment. A further 34 subjects were studied after cessation of gossypol treatment. A control group of 60 age-matched volunteers were monitored for 1 year. No significant changes in testosterone levels were observed during the course of study. Serum LH levels were, however, significantly higher (P less than 0.001) during earlier phases of gossypol treatment and returned to normal after cessation of treatment except in 14 men with persistent disruption of spermatogenesis. In the latter, serum levels of LH and testosterone were significantly higher (P less than 0.001) than those found in normal subjects and significantly lower (P less than 0.05) than in those subjects in which spermatogenesis had recovered. Serum FSH levels did not rise during the first 8-9 months of treatment with gossypol, although azoospermia generally occurred within 76 days of commencing treatment. After 9 months of treatment, serum FSH levels rose gradually and remained significantly elevated (P less than 0.001) after cessation of treatment in both the azoospermic/oligospermic group and in the group in which spermatogenesis recovered. In the latter group the serum levels of FSH were correlated significantly with the sperm concentration.     

Modulation of immunoradiometric and bioactive follicle stimulating hormone secretion and clearance in young and elderly men during treatment with tamoxifen or flutamide.

The secretion and clearance of immunoactive and bioactive follicle-stimulating hormone (FSH) in healthy young men (N = 10) and elderly men (N = 7) during blockade of endogenous sex steroid hormones with tamoxifen, an antiestrogen, and flutamide, an antiandrogen, was investigated. To this end, subjects underwent blood sampling basally every 10 minutes for 24 hours, and then received 2 consecutive intravenous pulses of synthetic gonadotropin releasing hormone (GnRH; 10 micrograms and 100 micrograms) every 2 hours. This paradigm was repeated on two subsequent visits, in which subjects received either flutamide HCl, a specific nonsteroidal competitive antagonist of the androgen receptor (750 mg daily for 3 days), or tamoxifen, a selective antagonist of the estrogen receptor (20 mg daily for 9 days). Serum immunoactive FSH concentrations were measured in each sample by immunoradiometric assay (IRMA). Serum bioactive FSH concentrations were determined by an in vitro bioassay (rat granulosa cell aromatase system) on 24-hour serum pools. Deconvolution analysis was used to analyze both the FSH IRMA 24-hour time series and FSH release after GnRH. Comparisons between young and elderly men of the basal state showed significantly increased 24-hour mean serum immunoactive and bioactive FSH concentrations and significantly decreased free testosterone concentrations in elderly men. By deconvolution analysis, elderly men had a significant decrease in FSH secretory burst duration, and an increase in FSH half-life and FSH secretory burst amplitude compared with younger men. In response to sex steroid receptor blockade in young men, there was a significant increase in mean serum bioactive FSH concentrations during antiandrogen treatment, but not during antiestrogen treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Induction of spermatogenesis in men with azoospermia or severe oligoteratoasthenospermia after antegrade internal spermatic vein sclerotherapy for the treatment of varicocele

Aim:To evaluate the treatment outcome of antegrade internal spermatic vein sclerotherapy in men with non-obstruc-tive azoospermia or severe oligoteratoasthenospermia(OTA)as a result of varicocele.Methods:Between September1995 and January 2004,47 patients(mean age 33.8±6.3 years)underwent antegrade internal spermatic vein sclero-therapy for the treatment of varicocele with azoospermia(14 patients)or severe OTA(33 patients).Testicular corebiopsy was also performed in complete azoospermic patients who provided informed consent.The outcome wasassessed in terms of improvement in semen parameters and conception rate.Results:Forty-two(89.4%)of 47patients had bilateral varicocele,Serum follicle stimulating hormone(FSH)did not differ between patients withazoospermia and severe OTA.After the follow-up of 24.8±9.2 months,significant improvement was noted in meansperm concentration,motility and morphology in 35 patients(74.5%).Comparison between groups during thefollow-up revealed significantly higher values of sperm concentration,motility and normal morphology in the severeOTA group.Pregnancy was achieved in 14 cases(29.8%).Testicular histopathology of the azoospermic patientswith postoperative induction of spermatogenesis revealed maturation arrest at spermatid stage,Sertoli-cell-only(SCO)with focal spermatogenesis or hypospermatogenesis.None of the patients with pure SCO pattern or maturation arrestat spermatocyte stage achieved spermatogenesis after the treatment.Preoperative serum FSH levels didn't relate totreatment outcome.Conclusion:Antegrade internal spermatic vein sclerotherapy is an easy and effective treatmentfor symptomatic varicocele.It can significantly reverse testicular dysfunction and improve spermatogenesis in menwith severe OTA,as well as induce sperm production in men with azoospermia,improving pregnancy rates insubfertile couples.(Asian J Androl 2006 Sep;8:613-619)     

Hormonal contraception in Chinese men：variations in suppression of spermatogenesis with injectable testosterone undecanoate and levonorgestrel implants

Aim: To explore the causes of the difference in spermatogenic suppression between responders and non-responders in Chinese men treated with levonorgestrel (LNG) implants plus testosterone undecanoate (TU) injectable. Methods: The 16 Chinese volunteers treated were divided into two groups in regard to the sperm count during the treatment period, 7 men in the responder group (Group R), including 6 azoospermia and one severe oligozoospermia, and the remaining 9 in the non-responder group (Group N), including 4 oligozoospermia and 5 with sperm counts greater than 20×106/mL. The differences in serum profiles of FSH, LH, T, LNG and T/LH ratio were compared between the two groups and the correlation between the seminal fluid parameters and serum reproductive hormones was analyzed. Results: The serum FSH level was lower in Group R than that in Group N (P<0.05), while the serum LH and LNG levels were higher in Group R than those in Group N (P<0.05). The sperm density (P<0.01, r=0.235), motility (P<0.01, r=0.326)     

Indomethacin and oxaprozin lower seminal prostaglandin levels but do not influence sperm motion characteristics and serum hormones of young healthy men in a placebo-controlled double-blind trial

To evaluate the influence of indomethacin and oxaprozin on reproductive function in healthy young men, 34 volunteers with normal semen parameters were recruited. In a randomized double-blind design, 12 men were treated with placebo, 12 received 600 mg/day of oxaprozin and 10 took indomethacin 25 mg t.i.d. This treatment phase lasted for 14 days after which a follow-up period extended for another 10 weeks. Sperm counts, percentage of motile and normally formed sperm cells, sperm velocity, linearity, lateral head displacement and beat frequency were evaluated by computerized image analysis once before treatment and at weekly intervals during the rest of the study. Prostaglandin levels in seminal plasma were significantly reduced after 2 weeks of treatment and remained suppressed for at least 2 additional weeks. In spite of this long lasting impairment of physiologic prostaglandin concentrations, no changes in any of the measured parameters were detectable when compared with the placebo group. Basal levels of testosterone, estradiol, LH, FSH, TSH and prolactin were unchanged. The response of hypophyseal hormones to a combined GnRH/TRH test before, during and after the treatment also was not affected. Overall, no negative influence of indomethacin or oxaprozin treatment on male reproductive function could be found in healthy volunteers. Since the active treatment phase was only 14 days, one can only speculate about long term effects of the tested drugs on reproductive parameters in men.     

Endocrine effects of oestrogen withdrawal in long-term treated patients with prostatic adenocarcinoma

Eighteen patients with prostatic adenocarcinoma, treated with oestrogen for 45 months or more, were followed-up after withdrawal of oestrogen treatment. Serum concentrations of testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), oestradiol-17 beta, testosterone-oestradiol-binding globulin (TeBg) and prolactin were measured at different intervals between 3 and 42 months after cessation of treatment. Serum testosterone concentrations after cessation of oestrogen treatment were low (range 71.4 +/- 6.3 to 120.8 +/- 23.7 nmol/100ml), whereas the concentrations of LH (range 21.8 +/- 3.6 to 32.6 +/- 9.1 U/1) and FSH (range 31.2 +/- 5.5 to 54.7 +/- 9.5 U/1) were within or higher than the reference range. Prolactin (range 6.0 +/- 85.3 to 7.9 +/- 68.2 micrograms/1) was within the reference range. No significant changes in serum concentrations of testosterone, LH, FSH and prolactin occurred during the follow-up period. The serum concentrations of both oestradiol-17 beta and TeBg, found between 13 and 36 months after oestrogen cessation (range 43.8 +/- 4.6 to 46.2 +/- 5.9 and 64.0 +/- 2.5 to 86.0 +/- 10.0, respectively) were significantly lower than the concentrations found between 3 and 12 months (range 71.9 +/- 10.4 to 99.8 +/- 12.9 and 124.1 +/- 15.5 to 140.2 +/- 13.7, respectively). It is concluded that in patients with prostatic adenocarcinoma, long-term oestrogen treatment causes an irreversible impairment of Leydig cell function and consequently a reduced testosterone secretion after cessation of oestrogen treatment.     

Treatment with the Gonadotropin-Releasinghormone Agonist Buserelin to Protect Spermatogenesis against Cytotoxic Treatment in Young Men/Behandlung zum Schutz der Spermatogenese bei cytotoxischer Therapie mit dem Gonadotropin-Hormon Agonisten Buserelin

We treated 20 young men, after giving informed consent, with buserelin during their tumor treatment period. 11 of them suffered from Hodgkins disease, 2 had a non-Hodgkin lymphoma, 6 had a seminoma and 1 patient had an embryonic carcinoma of the testis. 7 of these patients received cytostatic treatment with MOPP and/or ABVD, 9 patients had a radiation treatment, 3 received both treatments. One patient remained free of further treatment. Buserelin treatment was recommended to start at least 7 days prior to the tumor treatment, the interval ranged between 7 and 43 days. It ended on the same day as the tumor treatment or some days later, but this recommendation was followed only in 12 patients. 4 patients cessated buserelin treatment before end of the tumor therapy, and 4 other dropped out of the study. Testosterone plasma levels were measured before, during and after treatment with buserelin. 7 days after starting they were increased in most patients, while they were lower after 14 days and at the end of treatment period. Semen analysis showed sperm counts of 1 to 44 millions/ml with motility rates from 9 to 81%. In only ten patients we analysed a semen sample up to 6 months after cessation of treatment. In all but one we found azoospermia. Thus this treatment at now cannot be recommended in young men undergoing cytotoxic treatment to preserve fertility.     

血清和精浆抑制素B在无精子症诊断中的应用研究

目的:评价血清和精浆抑制素B浓度在诊断梗阻性和非梗阻性无精子症中的应用价值。方法:测定25例正常生育者(正常对照组),37例梗阻性无精子症以及33例非梗阻性无精子症者的血清卵泡刺激素(FSH)、血清和精浆抑制素B浓度,对无精子症者行睾丸病理Johnsen评分。结果:精浆和血清抑制素B浓度比值在正常对照组和非梗阻性无精子组分别为2.17和3.63,差异无显著性(P=0.29);在梗阻性无精子症组两者比值为0.18,与正常对照组和非梗阻性无精子症组比较显著降低(P<0.01)。结论:精浆和血清抑制素B浓度比值可用于临床诊断梗阻性和非梗阻性无精子症。     

Combination of subcutaneous levonorgestrel implants and transdermal dihydrotestosterone gel for male hormonal contraception

The primary aim of the present study was to determine the therapeutic dose of subcutaneous levonorgestrel (LNG) to induce azoospermia or severe oligozoospermia (<3 x 10(6)/mL) in normal men requiring contraception. Transdermal 5 alpha-dihydrotestosterone (DHT) was combined to the treatments to maintain peripheral androgen level. Forty-three 21-45-year-old healthy men were enrolled in this phase II randomised and comparative clinical performance study. The subjects were allocated to five groups to receive: (1) transdermal DHT (Andractim(R), Besins Iscovesco, Paris, France) and one subdermal LNG implant (Jadelle, Leiras, Turku, Finland); (2) transdermal DHT and two subdermal LNG implants; (3) transdermal DHT and four subdermal LNG implants; (4) transdermal DHT and oral LNG (Microluton, Schering, Germany); or (5) transdermal DHT only. A total of 27 men completed the suppression phase. None of them reached azoospermia. One subject with oral LNG and transdermal DHT reached <3 million/mL at 5 months of suppression, but not repeatedly. Together 2/27 (7%) subjects, one with oral LNG and DHT and the other with four subdermal LNG implants and DHT reached <5 million/mL temporarily. Altogether 9/27 (33%) subjects reached <20 million/mL. Serum testosterone concentrations (S-T) decreased significantly during the first 3 months of treatment with one, two and four LNG implants and DHT and during the next 3 months S-T remained significantly lower with two or four implants. Serum oestradiol concentrations (S-E(2)) decreased significantly during the first 3 months only with four implants, but at 6 months S-E(2) was lower also in the group with two implants. Serum luteinizing hormone (LH) decreased significantly only with two LNG implants and DHT gel at 5 and 6 months. Serum FSH did not decrease in any of the groups. None of the subjects filled the criteria to continue to the efficacy phase. A total of 16 men discontinued for various reasons. Of the 27 men completing the suppression phase, all have recovered to sperm levels >20 million/mL. There were no changes in blood count, lipid profile, liver function tests, prostate-specific antigen (PSA), sex hormone binding globulin (SHBG), prolactin or cortisol. The mixed antiglobulin reaction (MAR)-IgG, MAR-IgA or tray agglutination test (TAT) did not change during any of the treatments. The present study shows that the LNG implants themselves are well-tolerated by men and safe, and might be suitable for replacing part of the testosterone used as injections to reduce the androgen dose during male hormonal contraception. The DHT gel was considered as quite or very uncomfortable by 66% of the men because of feeling cold during the time it was on the skin, but noncompliance in using the gel was not reported by the men.     

Elevated end-of-treatment serum INSL3 is associated with failure to completely suppress spermatogenesis in men receiving male hormonal contraception

The administration of testosterone plus a progestogen functions as a male contraceptive by inhibiting the release of pituitary gonadotropins. After 3 to 4 months of treatment, most men are azoospermic or severely oligospermic (< or =1 million sperm/mL). However, 10% to 20% of men have persistent sperm production despite profound gonadotropin suppression. Since insulin-like factor 3 (INSL3) has been shown to prevent germ cell apoptosis in mice, we hypothesized that INSL3 might be higher in men with persistent spermatogenesis during treatment with male hormonal contraceptives. In a retrospective analysis, we measured serum INSL3 in 107 men from 3 recent male hormonal contraceptive studies and determined the relationship between suppression of spermatogenesis and serum INSL3. At the end of treatment 63 men (59%) were azoospermic and 44 men (41%) had detectable sperm in their ejaculates. Baseline INSL3 did not predict azoospermia; however, end of treatment serum INSL3 was significantly higher in nonazoospermic men compared with those with azoospermia (median [interquartile range]: 95 [73-127] pg/mL vs 80 [67-101] pg/mL; P = .03). Furthermore, serum INSL3 was positively correlated with sperm concentration (r = .25; P = .009) at the end of treatment and was significantly associated with nonazoospermia by multivariate logistic regression (P = .03). After 6 months of treatment with a hormonal male contraceptive regimen, higher serum INSL3 concentrations were associated with persistent sperm production. INSL3 may play a role in preventing complete suppression of spermatogenesis in some men on hormonal contraceptive regimens. This finding suggests that INSL3 may be a potential target for male contraceptive development.     

Daily testosterone and gonadotropin levels are similar in azoospermic and nonazoospermic normal men administered weekly testosterone: implications for male contraceptive development.

Weekly intramuscular administration of testosterone esters such as testosterone enanthate (TE) suppresses gonadotropins and spermatogenesis and has been studied as a male contraceptive. For unknown reasons, however, some men fail to achieve azoospermia with such regimens. We hypothesized that either 1) daily circulating serum fluoroimmunoreactive gonadotropins were higher or testosterone levels were lower during the weekly injection interval, or 2) monthly circulating bioactive gonadotropin levels were higher in nonazoospermic men. We therefore analyzed daily testosterone and fluoroimmunoreactive gonadotropin levels as well as pooled monthly bioactive and fluoroimmunoreactive gonadotropin levels in normal men receiving chronic TE injections and correlated these levels with sperm production. After a 3-month control period, 51 normal men were randomly assigned to receive intramuscular TE at 25 mg (n = 10), 50 mg (n = 9), 100 mg (n = 10), 300 mg (n = 10), or placebo (n = 12) weekly for 6 months. After 5 months of testosterone administration, morning testosterone and fluoroimmunoreactive follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were measured daily for a 1-week period between TE injections. In addition, fluoroimmunoreactive and bioactive FSH and LH levels were measured in pooled monthly blood samples drawn just before the next TE injection. In the 100-mg and 300-mg TE groups, mean monthly fluoroimmunoreactive FSH and LH levels were suppressed by 86%-97%, bioactive FSH and LH levels by 62%-80%, and roughly half the subjects became azoospermic. In the 1-week period of month 6, daily testosterone levels between TE injections were within the normal range in men receiving placebo, or 25 or 50 mg of weekly TE, but were significantly elevated in men receiving 100 or 300 mg of weekly TE. At no point during treatment, however, were there significant differences in daily testosterone or fluoroimmunoreactive gonadotropin levels, or monthly bioactive gonadotropin levels between men achieving azoospermia and those with persistent spermatogenesis. This study, therefore, demonstrates that neither monthly nor daily differences in serum testosterone, or fluoroimmunoreactive or bioactive gonadotropins explain why some men fail to completely suppress their sperm counts to zero with weekly TE administration. Innate differences in the testicle's ability to maintain spermatogenesis in a low-gonadotropin environment may explain persistent spermatogenesis in some men treated with androgen-based contraceptive regimens.     

Prolactin gonadotrophins in 208 men presenting with infertility

Prolactin, FSH and LH were measured in the plasma of 208 male partners of infertile marriages. We found 1 case of marked hyperprolactinaemia in 82 oligozoospermic men (1.2%). There was no difference in the mean prolactin levels of men with normal sperm counts and men with oligozoospermia or azoospermia. One-third of the men with azoospermia and with sperm density of less than 10 million had marked FSH elevation and our experience confirms the work of others that this indicates a poor prognosis.     

Testicular Function after Combined Chemotherapy for Metastatic Testicular Cancer

In 10 patients cured for metastatic testicular cancer by combination chemotherapy serum hormone levels and serum agglutinating antibodies were analysed 12 to 35 months after discontinuation of the treatment. Together with these examinations sperm analysis was done. All patients had increased levels of follicle stimulating hormone (FSH). Serum testosterone was usually in the lower part of the normal range (below 20 nmol/***l). In eight patients the serum agglutinating antibodies were normal, while two patients had increased levels. In all patients azoospermia was observed, indicating long-lasting infertility in patients testicular cancer treated by combination chemotherapy. The possible importance of cryopreservation prior to start of chemotherapy is discussed.     

Predictors for partial suppression of spermatogenesis of hormonal male contraception

Aim： To analyze factors influencing the efficacy of hormonal suppression of spermatogenesis for male contraception. Methods： A nested case-control study was conducted, involving 43 subjects, who did not achieve azoospermia or severe oligozoospermia when given monthly injections of 500 mg testosterone undecanoate （TU）, defined as partial suppressors compared with 855 subjects who had suppressed spermatogenesis （complete suppressors）. Sperm density, serum testosterone, luteinizing hormone （LH） and follicle stimulating hormone （FSH） concentrations at the baseline and the suppression phase were compared between partial and complete suppressors. Polymorphisms of androgen receptor （AR） and three single nucleotide variants and their haplotypes of FSH receptor （FSHR） genes determined by polymerase chain reaction （PCR） and DNA sequencing technique were compared between 29 partial and 34 complete suppressors. Results： Baseline serum LH level was higher and serum LH as well as FSH level during the suppression phase was less suppressed in partial suppressors. Additionally, in a logistic regression analysis larger testis volume, higher serum FSH concentrations alone, or interaction of serum LH, FSH, testosterone and sperm concentrations were associated with degree of suppression. The distribution of polymorphisms of AR or FSH receptor genes did not differ between partial and complete suppressors. In cases with incomplete FSH suppression （FSH 〉 0.2 IU/L）, the chances of reaching azoospermia were 1.5 times higher in the subjects with more than 22 CAG triplet repeats. Conclusion： Partial suppression of spermatogenesis induced by 500 mg TU monthly injections is weakly influenced by hormonal and clinical features but not polymorphism in AR and FSHR genes.     

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.     

Reversible azoospermia induced by an androgen-progestin combination regimen in Indonesian men

The suppression of spermatogenesis by a combination of depot medroxyprogesterone acetate (DMPA) and testosterone enanthate (TE) was studied in Indonesian men. Twenty healthy, fertile volunteers were allocated randomly to either of two treatments each consisting of four intramuscular injections at monthly intervals. Group I (n = 10 men) received 100 mg DMPA plus 100 mg TE monthly while group II (n = 10 men) received 200 mg DMPA plus 250 mg TE monthly. Sperm concentration was suppressed markedly, with all men attaining azoospermia between the third and fourth month after the start of treatment. There was no significant difference in the suppression of spermatogenesis between the two dosage regimens. The median time to reaching azoospermia was 2.5 months from the onset of injections and the median time to recovery of sperm in the ejaculate was 2.0 months after cessation of treatment. Both steroid regimens were equally effective in suppressing LH, FSH and testosterone levels. Testosterone levels returned to baseline by the fourth post-treatment month while LH and FSH demonstrated significant rebound above baseline levels from 3 to 5 months after cessation of treatment. No serious clinical side effects were observed. Weight gain and increases in libido were reported during treatment by most volunteers. A transient decrease in libido was noted in 5/20 (25%) men between 1-2 months after cessation of injections, presumably due to the prolonged effects of DMPA relative to TE. These results indicate that uniform induction of reversible azoospermia with minimal side effects can be achieved in a non-Caucasian population.(ABSTRACT TRUNCATED AT 250 WORDS)     

Serum inhibin B as a marker for spermatogenesis

Inhibin B generated by Sertoli cells provides negative feedback on FSH secretion. In men, inhibin B seems to be the physiologically important form of inhibin. Serum inhibin B was measured by two-site immunoenzymatic assay in 40 normal men (27 years of age) with sperm concentrations 100 +/- 9.2 x 10(6)/mL, 51 subfertile men (31 years of age) with sperm concentrations 6.8 +/- 0.8 x 10(6)/mL, 16 men with varicocele with sperm concentrations 54.3 +/- 0.8 x 10(6)/mL (31 years of age), men with hypogonadotrophic hypogonadism, men with Klinefelter syndrome, and men with obstructive and non-obstructive azoospermia. In men with normal sperm concentrations (>20 x 10(6) mL) serum inhibin B was 201 +/- 17 pg/mL and FSH 4 +/- 0.5 IU/L. Varicocele patients showed normal sperm concentrations > 20 x 10(6)/mL, normal serum inhibin B (173 +/- 21 pg/mL), and normal FSH levels (4.6 +/- 0.6 IU/L). In patients with sperm concentrations < 20 x 10(6)/mL the inhibin B level was 118 +/- 14 pg/mL and the FSH level was 10 +/- 1.1 IU/L. In all patients, except those with hypogonadotrophic hypogonadism and Klinefelter syndrome. inhibin B and FSH were inversely correlated (r = -.41, p > 0.01). There was a positive correlation between inhibin B and sperm concentrations (r = .34, p < .01). In varicocele men there was a correlation of r = .574, p < .05. Inhibin B may be a marker of exocrine testicular function and may offer an improved diagnosis of testicular dysfunction.     

Male reproductive potential after MOPP therapy for Hodgkin's disease: a long-term survey

Summary.  The testicular function of 47 men who had been treated by MOPP chemotherapy for a Hodgkin's disease was studied in a long-term survey. Azoospermia was constant during at least 14 months after completion of the treatment. After a follow-up period of 89.4 ± 54.7 months, 26 men were still azoospermic. No correlation could be found between the therapeutic regimen and the results of semen analysis. For the same treatment, some men recovered spermatogenesis within 5 years, others after more than 10 years while some were still azoospermic after 20 years. However, the association of infra-diaphragmatic irradiation to high dose MOPP therapy had a profound detrimental effect on spermatogenesis: only 3/13 men recovered. Sperm recovery was often incomplete: 17/21 men had a sperm count below 20 million ml^-1. Yet, spontaneous pregnancies were obtained with severe oligozoospermia: only 1/11 sperm counts performed close to fertilization exceeded 20 million ml^-1, and 8 were below 5 millions ml^-1. FSH failed to be either a sensitive or a specific marker of sperm recovery, a discrepancy between FSH level and spermiogram being noticed in 18.2% of cases.