The Treatment of Male Subfertility with Kallikrein

In a controlled double blind trial the effectiveness and tolerability of Kallikrein in patients suffering from astheno-oligozoospermia was examined in comparison to placebo. 30 patients with astheno-oligozoospermia of idiopathic origin entered the study; they were subdivided into two homogeneous groups of 15 patients each. Group A was treated with 600 K.U. daily for 3 months, group B received placebo tablets. In the Kallikrein group all parameters improved, as sperm motility, volume of semen, sperm concentration, total sperm value, and rate of normal spermatozoa. No changes of endocrinological findings were observed. Three pregnancies occurred in this group. No conceptions were observed in the wives of those patients treated with placebo (group B). Tolerability was very good in all patients.     

Serum Prolactin in Male Infertility

Hyperprolactinemia was found only in two out of 71 patients with male infertility and in none of 53 patients with impotentia coeundi indicating that hyperprolactinemia is of minor significance in these patients. There was only a weak negative correlation between hPRL and testosterone in oligozoospermic men. No correlation was found between hPRL and hLH, hFSH, sperm count and sperm motility. Nevertheless measurement of hPRL should be performed in all cases with hypogonadotropic hypogonadism, loss of libido or impotence since these symptoms may be signs of a prolactin-producing pituitary adenoma.     

Male Contraception: Clinical Assessment of Chronic Administration of Testosterone Enanthate

Testosterone enanthate (TE) was administered im to 39 normal adult men (age 21–39) to assess its efficacy as a suppressor of spermatogeneis and to determine possible adverse effects. 17 subject (Group A) received TE (200 mg/week) for 16 to 20 weeks. 16/17 lowered sperm counts (SC) to < 5 million/cc; 11/17 to < 300 000; and 10/17 became azoospermic. Group B received TE (200 mg/weeks); in 10/22 SC were < 5 million/cc at 16 weeks; 9/22 to < 300 000; and 5/22 azoospermic; when those with SC > 5 million/cc were switched to weekly treatment (additional 3–16 weeks), 9/12 lowered SC to < 5 million/cc. Overall, 19/22 of Group B attained this level. Serum LH and FSH were decreased on both regimens. These effects were dose-related. Mean serum testosterone was elevated above control (64%) in Group A, but remained at basal levels 2 weeks after TE injection in Group B. Decreasing the frequency of TE (3 or 4 weeks) resulted in a rebound of FSH and LH above baseline and increased SC. After discontinuing treatment, sperm counts and hormonal measurements returned to normal. Modest increase in body weight, red cell mass, oiliness of skin and mild acne were seen in some subjects. Liver function tests, glucose tolerance, blood lipids and renal function were unchanged.     

Silent Infection in Male Accessory Genital Organs and Male Infertility

Stumme Infektion der Adnexe des Mannes und Infertilität
In einer klinischen Studie wird über das Vorhandensein einer stummen Infektion der Adnexe des Mannes berichtet, die in einer Klientel von 350 Patienten 78 mal festgestellt werden konnte. Mit Ausnahme der Agglutination waren alle Spermaparameter signifikant verschlechtert in der Infektionsgruppe gegenüber einen Kollektiv von 36 gesunden Männern. Das Ejakulatvolumen war signifikant größer als normal. Es ergab sich weiterhin eine Leukocytose, sowie als Zeichen der Prostata-Unterfunktion ein reduzierter Wert für die saure Phosphatase und die Zitronensäureaktivität im Sperma. Für einen Zeitraum von 2–4 Wochen wurde eine Chemotherapie durchgeführt, worunter sich die Leukocytose und das Sperma vorübergehend besserten. Lediglich die saure Phosphatase war drei Monate nach der Behandlung normal. Es wird angenommen, daß folgende Ursachen der Infertilität bei der stummen Infektion maßgebend sind: 1) Unterfunktion der männlichen Geschlechtsorgane, verursacht durch eine primäre, heftige Infektion zu einem früheren Zeitpunkt und 2) chronische, klinisch nicht faßbare Infektion der Adnexe des Mannes, vornehmlich als Komplikation der primären Infektion. Eine Chemotherapie, die lediglich für 4 Wochen vorgenommen wird, dürfte nicht ausreichend sein, um die stumme Infektion auszuheilen.     

Semen Quality and Sex Hormone Pattern of 39 Middle Aged Men

Thirty-nine men with sexual disturbances in middle-age (52-68 years) were included in this study. Semen samples were obtained by masturbation and were analysed for its composition Serum was prepared and analysed for FSH, LH, prolactin and testosterone. Results were compared with the values obtained in a recent study by the authors on a young fertile group (Homonnai et al. - 1980). Hormonal evaluation revealed a significant increase in FSH, LH, and prolactin concentrations, Testosterone levels were not different in the two groups (old v:s young). Nevertheless, accessory gland functions were depressed, semen volume decreased by 30% and fructose secretion by the seminal vesicle was diminished significantly. The average sperm concentration and morphology were not different than in young group but their quality in terms of motility and vitality was depressed. Sperm production by the tests was decreased by 30% compared to the young control group. Increased serum prolactin levels and elevated estrogen activity may be responsible for the sexual disturbances known in older men.     

Plasma Cholesterol, Triglycerides, FSH and Testosterone Levels of Normolipemic Male Patients with Decreased Fertility Treated with Mesterolone

There were no changes in plasma cholesterol, triglycerides, FSH and testosterone levels of 24 healthy men treated with mesterolone for infertility during period of 6 months. The patients were normolipemic and the daily doses were 75 mg. No side-effects were noticed. Mesterolone seems to have too selective or too low androgenic effect with the doses used in order to have an influence on the lipid metabolism of men.     

The Effects of Mesterolone on the Male Accessory Sex Organs, on Spermiogram, Plasma Testosterone and FSH

Der Einfluß von Mesterolon auf die akzessorischen männlichen Geschlechtsorgane, auf das Spermiogramm, Plasmatestosteron und FSH
Bei 42 Männern mit Subfertilität (mäßige Oligozoospermie) wurde eine Therapie mit Mesterolon in der Dosierung von 3 × 25 mg tgl. über 6 Monate durchgeführt. Diese Behandlung führte zu keiner Änderung des Plasma FSH, Plasma-Testosteron und der Prostataphosphataseaktivität, während die Aktivität der sauren Phosphatase und die Citronensäure im Spermaplasma anstiegen. Die Fructosewerte zeigten eine rückläufige Tendenz, was mit einem Anstieg der Spermatozoendichte erklärt wird. In 93% ergab sich eine Besserung oder keine Änderung des Spermiogramms. In 30% ergab sich eine Normozoospermie. 6 Schwangerschaften wurden beobachtet.
Mehr als 50% der Patienten gab an, daß die Behandlung sich positiv auf ihr Allgemeinbefinden auswirkte. Etwa 30% gab eine Steigerung der sexuellen Aktivität 2–3 Wochen nach Beginn der Behandlung an; dieser Effekt war jedoch vorübergehend.
Negative Einflüsse auf den Zustand der Prostata wurden nicht festgestellt.     

Testosterone Regulation of Luteinizing Hormone Secretion in the Male Dog

In the first experiment, plasma levels of testosterone (T) and LH were determined in male mongrel dogs following castration. Blood samples were collected every 4 h for 48 h and daily from days 3–12 post-castration. Plasma T concentrations became undetectable by 8 h post-castration, and remained undetectable until the end of the study. Plasma LH concentrations were undetectable for 16–20 h post-castration, but increased to 4.5 ng/ml by 24 h. By 48 h, post-castration, the LH reached 12.5 ng/ml, similar to levels reported previously in the castrated male dog.
In a second experiment, studies were carried out to determine the effect of various numbers of T-filled polydimethylsiloxane (PDS) capsules on plasma concentrations of T and LH in castrated male dogs. Dogs were implanted with either 1 empty PDS capsule or 1, 3, or 5 T-filled PDS capsules. Blood samples were collected daily prior to implantation, following implantation, following castration, with capsules left in situ and following capsule removal. Replacement of T, using one T-filled capsule, did not prevent the post-castration rise of LH. Replacement of T. using 3 and 5 T-filled capsules, maintained intact concentrations of both LH and T in castrated dogs. Removal of capsules from castrated dogs resulted in hypersecretion of LH similar to that observed in the first experiment. These studies indicate that T replacement within physiological limits will maintain LH in the castrated male dog at concentrations similar to those observed in the intact, untreated animal.     

The Endocrine Status of Gossypol — Treated Male Rats*

Der endocrine Status von Gossypol-behandelten männlichen Ratten Männliche, adulte Wistarratten erhielten 2.5–30 mg/kg Gossypol-Essigsäure (GAA) 10–20 Wochen lang täglich oder jeden zweiten Tag oral verabreicht. Die Kontrolltiere erhielten das GAA-Suspensionsmittel allein oder blieben vollkommen unbehandelt. Es wurden die Serumkonzentrationen von Testosteron, LH und FSH sowie die Gewichte der Hoden, Nebenhoden, Prostata, Samenblasen, Koagulationsdrüsen und Hypophyse bestimmt. Zusätzlich wurden die akzessorischen Geschlechtsdrüsen licht-mikroskopisch untersucht. Eine signifikante Erniedrigung der Fertilität dieser Tiere wurde mit GAA-Konzentrationen ab 15 mg/kg erreicht. In allen GAA-Behandlungsgruppen unterschieden sich weder die gemessenen Hormonkonzentrationen noch die Gewichte der Reproduktionsorgane signifikant von denen der Kontrollgruppen. An den Prostatae, Samenblasen und Koagulationsdrusen waren keine histologischen Veränderungen verglichen mit den Kontrollorganen feststellbar. Offensichtlich führt die Verabreichung von GAA zu keiner Beeinträchtigung des Hypothalamus-Hypophysen-Gonaden-Systems bei adulten, männlichen Ratten.     

巨噬细胞对不育男子精液质量的影响

本文应用免疫细胞化学方法,研究正常生育男子、不育男子精液中巨噬细胞水平变化,同时,分析精液质量参数.结果显示不育组精液巨噬细胞显著增高;巨噬细胞阳性组与阴性组比较,活动率,活动力,尾部肿胀率均显著降低,畸形率明显增高;尾部肿胀率,畸形率与巨噬细胞含量分别呈负相关和正相关.研究提示在男性不育症患者精液中巨噬细胞有较高发生率,精液巨噬细胞数量变化可影响精液质量,造成男性不育的机理有待进一步研究.     

Male infertility： risk factors in Mongolian men

Aim: To determine the most common risk factors of male infertility in Mongolian men attending an infertility clinic. Methods: A prospective, case-control study was conducted in which 430 men were enrolled. All the men had sought their first infertility evaluation between 1998-2002 in the State Research Center on Maternal Child Health, Ulaanbaatar, Mongolia. They were divided into two groups depending on the results of their semen analysis:191 with abnormal semen and 239 with normal semen profile. Univariate and multivariate analyses were performed to determine any association between risk factors and semen abnormality. Results: Logistic regression analysis demonstrated that the testicular volume, a history of sexually transmitted infections (STI), epididymitis and testicular damage all have statistically significant associations with semen abnormality, when controlled for multiple risk factors.Adjusted odds ratios of 3.4 for mumps orchitis, 2.3 for other orchitis and 3.9 for testicular injury were found.Gonorrhoea, the most commonly reported STIs in this study, gave an adjusted odds ratio of 1.0 for having one or more sperm abnormality. An adjusted odds ratio for subjects with a history of other STIs was 2.7. However, as a predictor of azoospermia, STIs had very high odds ratio, being 5.6 in patients with gonorrhoea and 7.6 in patients with other STIs. Conclusion: A history of pathology involving testicular damage appeared to have the strongest impact on male infertility in Mongolia. STIs have less impact on semen quality except when complicated by orchitis, epididymitis and vasal obstruction. (Asian J Androl 2004 Dec, 6: 305-311)     

Effect of Prostaglandins A-1, E-2 and F-2a on Blood Plasma Levels of Testosterone, LH and FSH in Male Rats

Effects of the administration of PGs A-1, E-2 and F-2 alpha (150 micrograms/rat b.i.d. for 10 days) were studied. Significant increase in testicular weight was observed only in PGE-2 treated group. Testicular ascorbic acid content reduced significantly by treatment with all the PGs. PGE-2 treatment caused a significant decrease in the content of testicular cholesterol, while no change was observed in the same and prostatic acid phosphatase activity in any of the PG treated groups. Blood plasma levels of testosterone drastically reduced by both PGE-2 and PGF-2 alpha, while there was no change in the levels of plasma LH in any of the groups. Plasma FSH levels increased significantly in PGA-1 treated rats only. The results suggest that 1) There is a direct action of PG particularly PGE-2 on testicular weight. PGE-2 increases testicular weight possibly by preventing degeneration of spermatids, 2) PGE-2 acting directly on the testis, reduces testicular ascorbic acid content, stimulates the conversion of cholesterol to pregnenolone but depresses the conversion of the latter to testosterone.     

Kallikrein Therapy of Infertile Men with Varicocele and Impaired Sperm Motility: Therapie mit Kallikrein bei infertilen Männern mit Varicocele und reduzierter Spermatozoenmotilität

A randomized group of 65 men with oligoasthenozoospermia and left side varicocele was subjected to a controlled study with kallikrein. Kallikrein (600 units orally per day) was given to 38 men for a period of 3 months. The other group of 27 men remained untreated but were followed up during the same period of time. After kallikrein treatment significant improvements in sperm quality could be observed: percentage of motile spermatozoa from 24.47 +/- 9.01 to 35.26 +/- 11.80, percentage of morphologically normal spermatozoa from 58.42 +/- 5.86 to 71.05 +/- 8.12. There was no improvement in sperm parameters in the untreated group of men. The results suggest that kallikrein therapy is useful for those men who refuse an operative or radiologic treatment of their varicocele and also as a primary or associated therapy of patients who underwent ligature or occlusion of spermatic veins.     

Relationship between hormone profiles and the restoration of spermatogenesis in men treated with gossypol

Gossypol acetic acid was administered orally to 35 male volunteers at a dose of 20 mg once a day for 52-70 days in the loading phase and twice a week for 22 months in the maintenance phase. Sperm counts and the serum concentrations of LH, FSH, prolactin, testosterone and oestradiol were monitored regularly during treatment and for a follow-up period of 12 months. At around 90 days after treatment, all treated participants approached or attained azoospermia and remained at this level throughout the maintenance phase. By the end of the follow-up phase, eight treated men were still azoospermic, while sperm counts in the other 27 men were restored to normal levels. The only hormone that changed significantly during and after the treatment was FSH. From the 6th month of the treatment to the end of the follow-up phase, serum concentrations of FSH in the eight participants that reached irreversible azoospermia were significantly higher than in the other 27 men or in controls. It is suggested that monitoring of FSH levels might be of diagnostic use for identifying those participants with irreversible azoospermia during gossypol treatment.     

Endocrine and reproductive health status of men who had experienced short-term radiation exposure at Chernobyl

Hormonal and semen parameters in 416 men aged 25–45 years were examined: 328 were men who cleaned the territory around the Chernobyl nuclear reactor (called `liquidators') and 88 were healthy age-matched controls. The dose of radiation received by the liquidators was 0.16 ± 0.08 Gy. LH, FSH, prolactin, testosterone and cortisol levels were assayed using WHO -matched reagents. Semen analyses were performed according to the WHO Manual (1992 ). The mean concentration of all hormones in liquidators and controls were within the WHO-defined normal range. The mean levels of LH and cortisol in liquidators were significantly lower ( p  = 0.013 and p  < 0.001, respectively) and testosterone significantly higher ( p  = 0.023) than in controls. The variations in hormone levels in liquidators were not correlated with the acquired doses of radiation as measured by personal dosimeters (film badges). Semen parameters in a sub-group of 70 liquidators were within the normal WHO-defined range. The percentage of normal forms of spermatozoa in liquidators (35.0 ± 13.1%) was significantly lower ( p  < 0.015) than in a control group (42.8 ± 8.9%). The study has shown that exposure of men to relatively short-term radiation did not cause long-lasting disruption of their endocrine status and spermatogenesis. The study was 7–9 years retrospective and it is therefore impossible to infer what the immediate effects of the radiation exposure were on these parameters.     

男性不育患者精液质量与精子顶体酶活性关系分析

目的:分析男性不育患者精液参数与精子顶体酶活性变化,探讨精液质量与顶体酶活性的关系。方法:对214例男性不育患者的精液作精子顶体酶活性、弹性蛋白酶、果糖、α葡糖苷酶、锌、酸性磷酸酶、精子尾部低渗肿胀试验检测,同时精子质量检测仪作精液分析。以检出精子顶体酶活性正常的(48.2~218.7μIU/106精子)111例作为对照组,与顶体酶活性异常(<48.2μIU/106精子)的103例精液参数作对比分析。结果:两组精液参数的精子密度、精子活动率、a+b级精子百分率、精子尾部低渗肿胀试验差异均有非常显著性(P<0.001)。弹性蛋白酶差异有显著性(P<0.05)。果糖、α葡糖苷酶差异亦有显著性(P<0.05)。精液量、锌、酸性磷酸酶差异无显著性(P>0.05)。结论:精子顶体酶活性与精液质量关系密切,精子顶体酶活性是反映精液质量的一项可靠指标。     

虎杖丹参饮治疗免疫性不育男性的临床研究

目的:探讨中药“虎杖丹参饮”治疗免疫性不育男性的临床疗效,为临床采用中医药治疗免疫性不育男性提供一种有效方法。方法:将符合纳入病例标准的90例患者随机分成两组,治疗组60例,采用口服“虎杖丹参饮”治疗;对照组30例,采用口服泼尼松治疗,分别治疗3个月,观察两组治疗前后临床症状改善、免疫指标[血清抗精子抗体(AsAb),精浆AsAb]、精液质量指标(液化时间、活力、活动率、密度、畸形率等)的变化,并对上述结果进行统计学分析。结果:①治疗组AsAb总转阴率明显优于对照组(P<0.01),其中血清AsAb转阴率疗效更好;②治疗组临床治愈率及总有效率明显优于对照组(P<0.01),治疗后的中医症状积分明显低于对照组(P<0.01),治疗组在改善临床症状方面明显优于对照组(P<0.01),尤以改善腰膝酸软、会阴睾丸坠胀、性欲强烈、局部疼痛症状明显;③治疗组治疗后精子活力、活动率明显优于治疗前(P<0.01),精子密度明显优于治疗前(P<0.05),而治疗前后的精液量、液化时间、精子畸形率及pH值没有明显差异(P>0.05)。结论:“虎杖丹参饮”治疗免疫性不育男性的疗效明显优于泼尼松。“虎杖丹参饮”能较好地提高AsAb转阴率,改善临床症状和精子质量,且无明显不良反应。“虎杖丹参饮”是治疗免疫性不育男性的有效方法。     

Temporal changes in the serum levels of gonadotrophins and testosterone in male rats bearing subcutaneous implants of 5α-dihydrotestosterone

This study has assessed the effect of s.c. implants of 5 alpha-dihydrotestosterone (DHT) on the blood levels of testosterone and gonadotrophins in intact and castrated adult male rats. The rats were bled via cardiac puncture at 1, 3, 7, 14, 21, 28, 35, 42, 49, 56, 63 and 70 days after DHT implantation. On days 28 and 49 post-implantation, rats were injected with LHRH (25 ng) and bled 15 min later. In intact rats bearing DHT implants, the serum levels of LH and testosterone were suppressed significantly with no significant changes in FSH levels. Ventral prostate, seminal vesicles and the pituitary were reduced significantly in weight when compared with controls with empty implants. DHT significantly inhibited LHRH-induced release of FSH in intact rats. In castrated rats, DHT implants inhibited the secretion of both LH and FSH, with a rise in serum DHT levels. DHT stimulated the LHRH-induced release of LH but inhibited FSH. DHT implants increased the weight of the seminal vesicles and ventral prostate but inhibited the weight of the pituitary when compared to castrated rats bearing empty implants. This study demonstrates specific inhibition of serum LH and testosterone by DHT implants in intact adult rats.     

Effect of paracetamol on semen quality

Several published studies, both direct and indirect, have connected paracetamol, also named acetaminophen, a commonly used over‐the‐counter analgesic and antipyretic medication, with semen quality and male infertility, although as yet this connection is unclear. This review addresses the effect of paracetamol on semen quality and hence on male factor infertility. We searched the MEDLINE database from January 1980 through January 2017 for English‐language articles using the key words “paracetamol” and “acetaminophen” versus “sperm.” References from articles were used only if relevant. In summary, paracetamol, when used at high doses, appears to change semen quality, particularly sperm morphology, and hence its fertilising ability. Such effect of paracetamol on semen quality may occur by suppressing testosterone synthesis, inducing oxidative stress, provoking apoptosis of spermatocytes, reducing nitric oxide production and inhibiting prostaglandin synthesis. Further research, particularly clinical research, will be very important to confirm these effects.