Testicular growth, sperm concentration, percent motility, and pregnancy outcome after varicocelectomy based on testicular histology

OBJECTIVE: To evaluate the outcome following surgery in two different patterns of testicular histology in patients with varicocele. DESIGN: Prospective study. SETTING: Academic medical center. PATIENT(S): Sixty patients underwent varicocelectomy and had a testicular histology diagnosis of germ-cell aplasia (group I, n = 28) or maturation arrest (group II, n = 32). INTERVENTION(S): Varicocelectomy. MAIN OUTCOME MEASURE(S): Preoperative hormone levels, testicular size, and sperm parameters. After varicocelectomy, variations in testicular size, semen parameters, and pregnancy rates were evaluated. RESULT(S): The mean volume of the right and left testicle was smaller in group I patients than in group II. In addition, the mean sperm concentration before treatment was lower in group I than in group II. The mean volume of the left and right testicle increased in group I after the intervention. The mean postoperative sperm concentration and motility in group II showed no increase, whereas the mean sperm concentration in group I did increase. The pregnancy rate was higher in group II (14/26, 53.8%) than in group I (4/16, 25%) (P=.02). CONCLUSION(S): Patients with germ-cell aplasia present a postoperative increase in testicular size but the pregnancy rate is higher in patients with maturation arrest following surgery.     

Evaluation of testicular microlithiasis in varicoceles

Background:  Testicular microlithiasis is said to be characterized by calcific concretions within the seminiferous tubules. There have been reports suggesting a link between testicular microlithiasis and testicular dysfunction and tumors.
Methods:  In this study, we assessed subjects with varicoceles detected by using testicular ultrasound, and evaluated the cases of testicular microlithiasis in terms of age, seminalysis findings, and endocrinological parameters (testosterone, follicular stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL)). The subjects comprised 224 patients with varicoceles diagnosed by using testicular ultrasound, who attended this institution as outpatients between January 1998 and August 2000.
Results:  Testicular microlithiasis was detected in 15 out of 224 subjects (6.7%), bilateral in all cases. No significant differences were seen between the group with testicular microlithiasis and the group without testicular microlithiasis, in terms of age, seminalysis findings, and/or endocrinological parameters (testosterone, FSH, LH, prolactin). The incidence of testicular microlithiasis in outpatients undergoing testicular ultrasound varies between reports, but is of the order of 0.6–2.0%.
Conclusion:  In this study, we found a high proportion of testicular microlithiasis at 6.7%, strongly suggesting a link with male infertility. (Reprod Med Biol 2002; 1 : 75–79)     

Semen and hormonal parameters in men with chronic hepatitis C infection

Male patients with chronic hepatitis C virus (HCV) infection (n = 57) demonstrated a statistically significant decrease in semen volume, sperm count, and progressive sperm motility and a statistically significant increase in abnormal sperm morphology compared with healthy controls (n = 40). The duration of the HCV infection was negatively correlated with semen volume and sperm motility where the HCV RNA viral load was negatively correlated with sperm count and sperm motility. Chronic HCV patients had statistically significantly lower total serum testosterone and higher serum E(2) and prolactin levels compared with healthy controls.     

Semen parameters in 114 fertile men

We studied the quality of semen in 114 fertile men (their wives were in the first trimester of pregnancy), aged 31.9 ± 5.7 yr. The results (mean ± S.D.) were as follows: number of spermatozoa, (72 ± 61.6) · 10⁶/ml; motile spermatozoa, 56.6% ± 13.5; spermatozoal velocity, 34.2 ± 4.3 μm/s; motility index, 19.5 ± 5.6 μm/s; normal forms, 51.7% ± 13. It was found that the percentage of motile spermatozoa and the index of motility decrease progressively, at a rate of about 5–10% per hour. In contrast, in the majority of cases, sperm velocity increases during the first 4 h. Low significant correlation was found between percentage of motility and spermatozoal velocity the first hour after ejaculation. Furthermore, moderate significant correlations were found between number of spermatozoa/ml, percentage of motility and normal forms. Finally, low significant negative correlation was found between number of spermatozoa/ml and spermatozoal velocity.     

Comparison of gonadal function between fertile and infertile men with varicoceles

The high prevalence of men with varicoceles who by history are fertile has led some to question the suggested causal relationship between a varicocele and male infertility. However, testicular function in these fertile men has not previously been studied in detail. Fifty-five normal fertile men, 42 fertile men with varicoceles, and 24 infertile men with varicoceles and normal female partners were studied. Semen analyses were done, baseline serum testosterone and gonadotropin levels tested and the gonadotropin response to luteinizing hormone-releasing hormone (LH-RH) measured. The infertile men with varicoceles exhibited lower sperm counts, abnormal sperm morphologic features, increased baseline serum gonadotropins, and increased gonadotropin responses to LH-RH, compared with the normal fertile men. The fertile men with varicoceles showed similar abnormalities, although this was not statistically significant in all cases. That semen and hormone abnormalities were observed in both the fertile and infertile men with varicoceles suggests that the presence of a varicocele is associated with some degree of primary testicular dysfunction, regardless of present fertility status.     

Semen parameters in patients with unilateral testicular cancer compared to patients with other malignancies

Aim The aim of our study was to evaluate pretreatment semen quality in patients with unilateral testicular cancer in comparison to semen parameters of patients suffering from other malignancies.Methods Semen analysis according to WHO recommendations were performed in 16 patients suffering from unilateral testicular cancer (group 1) and in 21 patients who were diagnosed to have other malignant tumors (group 2: non-Hodgkin's lymphoma: n=7, Hodgkin's disease: n=6, leukemia: n=3, osteosarcoma: n=2, rectal cancer: n=2, thyroid carcinoma: n=1) prior to anti-cancer treatment.Results Normozoospermia was observed in none of the testicular cancer patients but in five of the other patients (p=0.047). Sperm concentration was significantly decreased in the patients of group 1 compared to those of group 2 (18.7±22.3×10⁶/ml versus 35.6±31.3×10⁶/ml, p=0.03). The percentage of rapid progressive motile spermatozoa was significantly less in testicular cancer patients than in patients suffering from other malignancies (WHO group a: 1.1±2.0% versus 4.7±5.6%, p=0.02). Normal morphological findings of spermatozoa were found in a smaller percentage in group 1 (16.2±6.0% versus 26.1±18.0%, p=0.03).Conclusions Our investigations revealed that especially testicular cancer has an adverse influence on sperm quality. Hence, we advise careful and sufficient cryopreservation of semen in those patients taking the negative impact of cytotoxic treatments on semen parameters into account.     

单侧隐睾史不育患者的精子参数评价

目的:评价患者施行睾丸固定手术时的年龄对其后精子参数的可能影响。方法:47例单侧隐睾史不育患者,按照患者施行单侧睾丸固定术时的年龄分为A组(2-7岁,n=23),B组(8-13岁,n=14)和C组(14-17岁,n=10)。对3组患者的精液作精液分析和精子头-尾膜的完整性检测。结果:3组患者的精液中均可观察到活动精子,精子活动率和精子浓度有很大的个体差异,畸形精子率普遍较高,精子头-尾膜完整率低。少弱畸精子症的发生率在B组(35%)和C组(50%)升高。结论:单侧隐睾史不育患者会有较差的精子参数。单侧隐睾症患者在幼年阶段尽早治疗有利于成年后的精子发生。     

Antisperm antibodies in infertile men and their correlation with seminal parameters

Aim:  Antisperm antibodies (ASA) in males cause the autoimmune disease 'immune infertility'. The present study intended to detect the presence of ASA and their incidence in men with unexplained infertility, as well as to evaluate the correlation between the presence of ASA and semen parameter alterations.
Methods:  Blood and sperm assessment were collected to carry out a direct and indirect mixed antiglobulin reaction (MAR) test and semen analysis in infertile and fertile men from the University Hospital of the Faculty of Medicine, Sao Paulo State University, Sao Paulo.
Results:  In the MAR test, 18.18% of infertile men were positive for ASA. In fertile men, no positivity was found. A significant correlation between the presence of ASA with an increased white blood cell count plus a decreased hypoosmotic swelling test result was observed.
Conclusions:  The results indicate that ASA are involved in reduced fertility. It is not ASA detection per se that provides conclusive information about the occurrence of damage to fertility. The correlation between infertility and altered seminal parameters reinforce the ASA participation in this pathology. (Reprod Med Biol 2007; 6 : 33–38)