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PubMed1991

Antisperm antibodies in the polyglandular autoimmune (PGA) syndrome type I: response to cyclical steroid therapy.

OBJECTIVE: To determine if cyclical intermediate dose steroid therapy could improve semen parameters in an infertile man with sperm autoimmunity associated with the polyglandular autoimmune (PGA) syndrome. DESIGN: Sperm agglutination studies performed before, during and after three courses of cyclical intermediate dose prednisolone therapy. PATIENT: A twenty-six-year old man with polyglandular autoimmune syndrome, consisting of Addison's disease, hypoparathyroidism, chronic mucocutaneous candidiasis and alopecia totalis, presented with infertility. He had normal endocrine testicular function but severe exocrine failure evidenced by a low sperm count (4.5 x 10(6)/ml), zero motility and universal sperm agglutination. MEASUREMENTS: Sperm agglutination tests. RESULTS: At presentation the gelatin agglutination test (GAT) was strongly positive in serum (1/1204) and seminal plasma (1/64) as was the tray agglutination test (TAT) (1/32). The patient's wife had a regular menstrual cycle with normal luteal phase progesterone levels. Following three courses of cyclical prednisolone (20 mg twice daily on days 1-10 of wife's cycle, and 5 mg on days 11 and 12), sperm quantity and motility improved considerably (12 x 10(6)/ml, 40% respectively) and sperm agglutination tests became negative. After a fourth course of therapy the patient's wife became pregnant. Three months post-treatment sperm motility was very low again and agglutinating activity in serum and seminal plasma increased. CONCLUSIONS: This is the first case of male infertility due to sperm autoimmunity in association with the PGA syndrome type 1. The immunosuppressive action of cyclical intermediate dose steroid therapy led to a significant quantitative and qualitative improvement in semen parameters.

Adult↗
PubMed1996

Effect of total and ionized calcium levels of seminal fluid on sperm motility.

Total and ionized calcium (Ca2+) levels of seminal fluid were assessed in 75 semen samples obtained from infertile patients and fertile patients referred to our clinic with different complaints. Patients who showed only motility disorders on sperm analysis were include into the study program. Forty-five patients showing hypomotility (motility < 60%) and 30 patients with normal motility (motility > or = 60%) on sperm analysis were evaluated comparatively. No significant difference was observed in the seminal fluid concentration of total calcium, regardless of spermatozoa motility immediately after ejaculation. However, the seminal fluid of men with hypomotility exhibited a significantly lower Ca2+ concentration (p < 0.05) when compared with that of men with normal motility. A significant difference was observed in the seminal fluid Ca2+/total calcium rate (p < 0.05) when compared with that of men with normal motility. Further, spermatozoa from men with hypomotility exhibited both a significantly lower progression rate and sperm count. Our study suggests a direct relationship between Ca2+ and sperm motility.

Adult↗
PubMed2002

[Cryopreservation of sperm before neoplasm therapy--7 years' experience].

OBJECTIVE: To compare sperm count of cancer patients with health men, to analyze possible relation of sperm pathology and diagnosis of malignant disease and present experience of our cryopreservation programme for cancer patients. DESIGN: Retrospective clinical study. SETTING: Department of Obstetrics and Gynecology, Masaryk University, Brno, Czech Republic. METHODS: 215 patients (age 25.4 +/- 5.6 years) were referred to our unit by oncology specialists for semen cryopreservation before cancer treatment during 1995-2001. Sperm samples were analysed according to guidelines of WHO. Richardson's medium and Planer Kryo 10 were used for standard cryopreservation. Sperm count results were compared to control group of 84 men (23.1 +/- 3.6 year) examined as possible sperm donors. Program SPSS version 9 was used for statistical analysis. Standard intracytoplasmic sperm injection (ICSI) using frozen spermatozoa was used for infertility treatment following malignant disease recovery. RESULTS: Testicular cancer was diagnosed in 115 (53.5%) patients, malignant disease of lymphatic and haemopoetic tissue in 75 (34.9%) cases--out of them 35 (16.3%) Hodgkin's lymphoma. Twelve men (5.6%) were treated for osteosarcoma and 13 for other malignant disease. Only 2.8% patients had normospermia. Severe oligospermia < 5 mil/ml was found in 73 men (33.9%) including 22 cases of azoospermia (10.2%) and 12 cases (5.6%) of cryptozoospermia. 138 (64.2%) patients had asthenospermia < 10% of progressive motility, 49 (22.8%) had terratozoospermia < 10% spermatozoa with standard WHO morphology. Sperm concentration, progressive motility and morphology were in cancer patients significantly lower (P < 0.001) than in control group. Men with testicular cancer had significantly higher frequency of severe sperm pathology. Only 4 patients have returned for assisted reproduction treatment. In all cases ICSI was used, 1 pregnancy and delivery was achieved. During more than 4 years after cryopreservation died 16.6% of patients. CONCLUSION: Cancer patients has significantly higher frequency of severe sperm pathologies than healthy men. The most severe sperm pathologies are among men with testicular cancer. Only minority of patients return for fertility treatment. Cryopreserved spermatozoa of cancer patients are able to initiate pregnancy by assisted reproduction techniques.

Adolescent↗
PubMed1998

A follow-up study of semen quality and fertility in men with varicocele testis and in control subjects.

OBJECTIVE: To evaluate semen quality and fecundity in a group of men with initially untreated varicocele testis, in comparison with control subjects. PATIENTS, SUBJECTS AND METHODS: In a prospective, longitudinal study, 77 men (39 with varicocele and 38 control subjects) were evaluated in 1989 and re-investigated after 8 years. Fifty-seven men (29 with varicocele, 28 controls) were available for evaluation and they all completed a questionnaire. Semen from a total of 46 men (24 with varicocele) was compared with findings in 22 men from the control group. RESULTS: There was a decline in sperm count in the control group from 80 x 10(6)/mL to 55 x 10(6)/mL over the 8-year period, but nearly no change in the sperm count in the men with varicocele. The withdrawal rate from each group was the same and included both men with and without reduced semen quality. There were no differences between the groups in sperm motility values (straight-line velocity, curvilinear velocity) evaluated using computer-assisted semen analysis. Paternity was achieved by 10 of 14 men in the varicocele group, compared with 14 of 16 in the control group. CONCLUSIONS: There was no evidence that varicocelectomy might benefit patients, because the sperm concentration did not decline among men with varicocele over time. Computer-assisted semen analysis provided a good assessment of various sperm motility characteristics and we recommend evaluation using such objective methods, to allow comparison among studies

Adult↗
PubMed2003

[Reproductive toxicity of metadoxine in rats].

OBJECTIVE: To study the reproductive toxicity of metadoxine. METHODS: Male and female rats were given metadoxine before pregnancy and early gestation, i.e. to feed metadoxine to male rats for 60 days before copulation and continue feeding during copulation, and feed metadoxine to female rats for 14 days before copulation. RESULTS: No significant toxic effect was observed in the 400 mg/kg group. A few rats showed paralysis of hind leg in the 800 mg/kg group. The dosage of 1 600 mg/kg caused significant paralysis of hind legs, emaciation, and reduced weight gain. In the 1600 mg/kg group, the mating rate of male rats was significantly affected (P < 0.01). In the 800 and 1 600 mg/kg group, fertility of male rats was markedly reduced (P < 0.01). In the 800 mg/kg group, the effect on sperm counts of epididymis of male rats was markedly reduced (P < 0.05). In the 1 600 mg/kg group, testicle weight and body weight ratio and sperm counts of epididymis rate were significantly (P < 0.001) reduced. In the 1 600 mg/kg group, the fertility rate of female rats was remarkably (P < 0.001) reduced. In the 800 mg/kg group, the weight gain of pregnant rats was significantly reduced (P < 0.001). In both the 800 and 1 600 mg/kg groups, the gestation rate was greatly reduced (P < 0.001). In the 800 mg/kg group, mortality rate before nidation (P < 0.001) and average live fetus number were significantly reduced (P < 0.05). In the 400 mg/kg group, the fetal weight was significantly reduced (P < 0.001). In the 800 mg/kg group, body length, tail length, body weight and sternum development of fetal rats were significantly affected (P < 0.001). CONCLUSION: Under the presented experimental conditions, metadoxine has no teratogenic effects on SD rats and the no effect dose is 400 mg/kg. And the no effect dose for the developmental toxicity is less than 400 mg/kg.

Animals↗
PubMedDate not supplied

Epididymal influence on acquisition of sperm motility in the gekkonid lizard Hemidactylus flaviviridis.

Total sperm count and percent sperm motility were noted in different parts of the epididymis, and the effect of anterior, middle, and posterior epididymal fluid on the induction of motility of nonmotile testicular spermatozoa was observed. The results were used to compare the influence of different parts of epididymis of Hemidactylus flaviviridis on the acquisition of sperm motility, which is a sign of sperm maturation. Spermatozoa collected from different regions of the ductus epididymidis showed considerable difference in their motility as well as total count with an increase from anterior to posterior region. The epididymal fluids from different regions induced the motility of testicular spermatozoa and the induction accelerated with increasing fluid volume and incubation period. Epididymal fluid at higher volumes induced the motility of nonmotile testicular spermatozoa significantly even at short-term incubation. Among different epididymal regions, fluid from posterior was more potent in influencing the motility than the fluids of middle and anterior. Motility pattern of spermatozoa varied from zig-zag, circular, and erratic in anterior to wavy in posterior region of epididymis. However, the mean sperm velocity did not show any regional variation.

Animals↗
PubMed1991

Preventive effects of methylcobalamin on the testicular damage induced by ethylene oxide.

In this study, the effects of methylcobalamin on testicular damage induced by ethylene oxide (EtO) were studied. When Wistar male rats inhaled EtO at 500 ppm, 6 h a day, 3 days a week, for 6 weeks, testicular damage was observed histopathologically and by some other parameters. Subcutaneous injection of methylcobalamin at 500 micrograms/kg, 5 times/week was found to ameliorate the damage. However, the degree of the methylcobalamin effect differed among the parameters examined in this study. Decrease in testicular weight due to EtO exposure was completely prevented by methylcobalamin, and decrease in testicular mature spermatid count and LDH-X activity was fairly well prevented. The degree of prevention of alteration in the epididymis, such as epididymal weight, epididymal sperm count and sperm abnormality rate, was significant but not complete. EtO caused apparent alterations in glutathione metabolism in the testes, but methylcobalamin did not affect such alterations induced by EtO. From these results, it has been determined that methylcobalamin has definite preventive effects on testicular toxicity of EtO.

Animals↗
PubMedDate not supplied

[Post-vasectomy semen in 313 males. Statistical analysis, medical aspects, legal implications].

The results of semen examination in 313 vasectomized males are presented. A quantitative analysis of the semen samples was performed according to the WHO criteria and the centrifugate of the entire ejaculate was studied. At the first semen examination, which was performed three months after the procedure, the sperm count per ml was negative in 210 patients (83.7%), positive (all non-motile and dead) in 41 (16.3%). Sixty-two patients did not send a sample. Those cases with a positive first examination had a regular examination every two months. At five months 90.8% of these cases had a negative count per ml. 3.6% of the patients required 7-10 months to have a negative count. It took longer for the older patients to have a negative count, the difference being statistically significant with respect to the younger patients. Examination of the centrifugate revealed spermatozoa in 24.3% of the samples with a negative sperm count per ml, although these were all non-motile and dead, except for one case who had motile spermatozoa at 3 months. There were no pregnancies or revasectomies. Some legal aspects relative to patient examination and follow-up are discussed.

Adult↗
PubMed1980

Chlorambucil treatment in minimal lesion nephrotic syndrome: a reappraisal of its gonadal toxicity.

Twenty-six preadolescent children ( 16 boys and 10 girls) with minimal lesion nephrotic syndrome, who were either unresponsive to or dependent on corticosteroid therapy, were treated exclusively with chlorambucil. Evaluation of chlorambucil toxicity on the reproductive system was based on penile and testicular size, serum testosterone values, and sperm count. Nine boys had azoospermia and one had oligospermia. The other six, who received a mean cumulative dose of 10.2 mg/kg of chlorambucil, had a normal sperm count. However, we consider that the total safe dose of chlorambucil should not exceed 8.2 mg/kg, equivalent to six weeks treatment at a daily dose of 0.2 mg/kg. In the ten girls, pubertal development was normal; axillary and pubic hair, breast development, age at onset of menarche, and length of the menstrual cycle were all normal; however, the possibility of abnormalities in ovarian functions cannot be excluded.

Adolescent↗
PubMed1989

Immunoreactive human epidermal growth factor in human seminal plasma.

We measured immunoreactive epidermal growth factor (EGF) by a homologous RIA in seminal plasma (SP) from 31 fertile and 52 infertile men to determine the relationship between SP EGF levels and total sperm count in the ejaculates. The mean SP EGF levels in fertile and infertile men were 41.7 +/- 21.5 (+/- SD) and 53.1 +/- 30.8 micrograms/L, respectively. Infertile men with sperm-associated immunoglobulin G (n = 9), immunoglobulin A (n = 6), or both (n = 8) had mean SP EGF levels of 48.9 +/- 26.1, 47.9 +/- 17.5, and 56.5 +/- 32.1 micrograms/L, respectively. Seven men with severe oligospermia had a mean SP EGF level of 58.5 +/- 35.9 micrograms/L. There was no correlation (r = 0.14; P greater than 0.05) between SP EGF levels and total sperm counts in these men. Fractionation of SP by high performance liquid chromatography on a size exclusion (TSK G2000 SW) column revealed a single immunoreactive peak with an approximate mol wt of 8000, slightly higher than the mol wt of circulating human EGF (6000). We conclude that SP EGF may be distinct from peripheral plasma EGF.

Adult↗
PubMed1990

Effects of chronic testosterone administration in normal men: safety and efficacy of high dosage testosterone and parallel dose-dependent suppression of luteinizing hormone, follicle-stimulating hormone, and sperm production.

In normal men, chronic testosterone (T) administration results in negative feedback suppression of gonadotropin and sperm production. However, azoospermia is achieved in only 50-70% of men treated with high dosages of T. Furthermore, the relative sensitivity of LH and FSH secretion to chronic administration of more physiological dosages of T is unclear. We determined whether a T dosage higher than those previously given would be more or less effective in suppressing spermatogenesis and whether, within the physiological range, T would exert a more selective effect on LH than on FSH secretion. After a 4- to 6-month control period, 51 normal men were randomly assigned to treatment groups (n = 9-12/group) receiving either sesame oil (1 mL) or T enanthate (25, 50, 100, or 300 mg, im) weekly for 6 months. Monthly LH and FSH levels by RIA and twice monthly sperm counts were determined. During treatment, T levels were measured daily between two weekly injections. Chronic T administration in physiological to moderately supraphysiological dosages resulted in parallel dose-dependent suppression of LH, FSH, and sperm production. T enanthate (50 mg/week) suppressed LH and FSH levels and sperm counts to 50% of those in placebo-treated men (ED50). T enanthate (300 mg/week), was no more effective than 100 mg/week in suppressing LH, FSH, and sperm production. Serum T levels in men who received 100 and 300 mg/week T enanthate were 1.5- and 3-fold higher than those in placebo-treated men, respectively. Except for mild truncal acne, weight gain, and increases in hematocrit, we detected no significant adverse health effects of chronic high dosage T administration. We conclude that 1) LH and FSH secretion are equally sensitive to the long term negative feedback effects of T administration; 2) sperm production is suppressed in parallel with the LH and FSH reductions induced by chronic T administration; and 3) even at the clearly supraphysiological dosage of 300 mg/week, T enanthate does not reliably induce azoospermia in normal men. However, there was also no evidence of a stimulatory effect of this T dosage on spermatogenesis. Furthermore, we found no evidence of major adverse health effects of T administered chronically even at the highest dosage.

Adult↗
PubMedDate not supplied

A randomized clinical trial of the effect of intraoperative saline perfusion on postvasectomy azoospermia.

BACKGROUND: We wanted to determine whether a saline flush during vasectomy would reduce the time needed to reach azoospermia. METHODS: During vasectomy men were randomly assigned to flush the prostatic end of the vas deferens with 10 mL of normal saline (intervention group, n = 50), while the remaining men (n = 56) served as controls. Sperm counts were performed on the immediate postprocedure urine specimen and on semen samples at 1, 6, and 12 weeks after vasectomy. RESULTS: The postprocedure urine specimens from the intervention and control groups contained 29.2 x 106 and 0.004 x 106 sperm, respectively (P < .001). Total sperm counts in the ejaculate for intervention and control groups at 1, 6, and 12 weeks were (in millions of sperm): 14.1 and 13.8, 0.4 and 8.0, and 0.0 and 0.011, respectively (P > .05 at all time points). There was no difference in the rate at which the men in the 2 groups achieved azoospermia. CONCLUSIONS: Vasal perfusion with saline during vasectomy was effective in removing sperm from the distal vas; however, perfusion did not increase the rate at which men achieve azoospermia.

Adult↗
PubMed1995

Environmental and dietary estrogens and human health: is there a problem?

It has been hypothesized that organochlorine pesticides and other environmental and dietary estrogens may be associated with the increased incidence of breast cancer in women and decreased sperm concentrations and reproductive problems in men. However, elevation of organochlorine compounds such as dichlorodipehenyldichloroethylene (DDE) and polychlorinated biphenyls (PCBs) in breast cancer patients is not consistently observed. Reanalysis of the data showing that male sperm counts decreased by over 40% during 1940 to 1990 indicated that inadequate statistical methods were used and that the data did not support a significant decline in sperm count. Humans are exposed to both natural and industrial chemicals which exhibit estrogenic and antiestrogenic activities. For example, bioflavonoids, which are widely distributed in foods, and several industrial compounds, including organochlorine pesticides and various phenolic chemicals, exhibit estrogenic activity. Humans are also exposed to chemicals which inhibit estrogen-induced responses such as the aryl hydrocarbon receptor (AhR) agonist 2,3,7,8-tetrachlorodibenzo-p-dioxin and related chlorinated aromatics, polynuclear aromatic hydrocarbon combustion products, and indole-3-carbinol, which is found in cruciferous vegetables. Many of the weak estrogenic compounds, including bioflavonoids, are also antiestrogenic at some concentrations. A mass balance of dietary levels of industrial and natural estrogens, coupled with their estimated estrogenic potencies, indicates that the dietary contribution of estrogenic industrial compounds is 0.0000025% of the daily intake of estrogenic flavonoids in the diet.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast Neoplasms↗
PubMed1989

[Sterility and tumors of the testis. Study of late exocrine and endocrine functions in stage I or IIA tumors].

Spermatogenesis and plasma hormone levels (testosterone, follicle stimulating hormone and 17 beta estradiol) were studied in patients presenting stage I or IIA testicular tumors. Patients with a previous history of cryptorchidism or varicocele, and those who had received combined chemotherapy, were excluded. In 22 patients (10 seminomas and 12 non-seminoma tumors) a spermogram was obtained at the time of orchidectomy, before the procedure in 9 cases and immediately afterwards in 13. Hormone levels, together with tumor marker assay (alpha feto protein and beta HCG) were determined preoperatively. Exocrine and endocrine function were restudied after 3 years of follow up. There was an initial restudied after 3 years of follow up. There was an initial deterioration in spermatogenesis in 17 patients (77.8%) as shown by a sperm count less than 20 million per cm3, an ejaculate volume less than 1.5 cm3 and a motility after one hour of less than 60%. In this group 11 patients had a sperm count of less than 10 million per cm3. Endocrine anomalies discovered included an increase in serum beta HCG levels (7 cases), combined with a decrease in follicle stimulating hormone and an increase in 17 beta estradiol. After 3 years, only 5 of these 17 patients demonstrated fertile sperm (29.4%). The endocrine anomalies tended to regress after orchidectomy. While these endocrine anomalies were always accompanied by hypofertility, their absence was not synonymous with a normal spermogram. Thus the reestablishment of fertile sperm remains unlikely even in early stage testicular tumors.

Adult↗
PubMed2001

Effect of androgenic anabolic steroids on sperm quality and serum hormone levels in adult male bodybuilders.

The purpose of this study was to assess the influence of the administration of high doses of androgenic anabolic steroids (AAS) on endocrine and semen parameters. Thirty volunteering bodybuilders were studied (ages ranging between 26.6 +/- 4.1 years). A history of anabolic steroid administration was recorded for fifteen subjects, and results of semen analysis and endocrine parameters were compared with data from fifteen bodybuilders not using steroids. In those subjects using AAS, eight had sperm counts under the lower normal limit (20 x 10(6) sperm/ml), three had azoospermia, two polyzoospermia, and two had normal sperm counts. The percentage of morphologically normal sperm was significantly reduced, only 17.7% had normal spermatozoa. In the control group, only one subject had oligozoospermia. The hormonal parameters revealed reduced FSH (1.5 +/- 3.2 vs 5.0 +/- 1.6, p < 0.001) and PRL (5.1 +/- 4.9 vs 9.2 +/- 4.4, p < 0.01) levels. LH, T, E2 and DHEA levels did not vary.

Adult↗
PubMed1982

Influence of abstinence and ejaculation-to-analysis delay on semen analysis parameters of suspected infertile men.

No significant differences were found between mean values calculated for daily increases in abstinence for any semen analysis parameter, with the exception of ejaculate volume between 1 and 2 days of abstinence. However, graphical analysis revealed significant trend lines for both ejaculate volume and total sperm count. The mean ejaculate volume increased by 1.0 ml between the first and second days of abstinence, and at approximately 0.3 ml/day thereafter until the 5th day. The total sperm count showed a mean daily increase of 50-60 x 10(6) spermatozoa/day. Quantitative differences exist in the evolution of these two parameters in comparison to normal fertile men. There were decreased mean percentages of motile and viable spermatozoa at short periods (less than or equal to 1 day) of abstinence, increasing up until the 2nd (% viable) or 3rd (% motile) days of abstinence, with decreased values at greater than 5 days. The mean percentage of morphologically normal spermatozoa was unaffected by the duration of abstinence. Delays of up to 3 hr between ejaculation and analysis did not seriously affect the mean semen parameters.

Ejaculation↗
PubMed1993

Comparison of a gonadotropin releasing-hormone antagonist plus testosterone (T) versus T alone as potential male contraceptive regimens.

Efforts to develop a hormonal contraceptive regimen for men have focused on administration of testosterone (T), alone or together with other agents. Previous regimens have successfully induced azoospermia in only 50-70% of subjects, however. GnRH antagonists, alone or in combination with T, have been shown to induce azoospermia in a very high percentage of nonhuman primates. We tested the hypothesis that the addition of a GnRH antagonist to a high-dose T regimen would lead to a higher percentage of men developing azoospermia than would T alone. We administered the GnRH antagonist, Nal-Glu (100 micrograms/kg.day sc), plus T enanthate, 200 mg im weekly or placebo sc injections daily plus T enanthate, 200 mg im weekly, to separate groups of healthy men for 16-20 weeks. Seven of 10 men who received Nal-Glu plus T and 6 of 9 men who received T alone became azoospermic; gonadotropin levels were suppressed and T levels were increased similarly in both groups. There was a trend toward higher pretreatment gonadotropin levels and lower sperm counts in men who became azoospermic. Weight gain, development of acne, and increases in hematocrit and hemoglobin were similar in the two groups. In the majority of the men, sperm counts returned to the baseline levels within 4-5 months after treatment ended. We conclude that with the dosages of Nal-Glu and T we used in this study, the addition of GnRH antagonist to a high-dose T regimen does not increase the ability of T to suppress spermatogenesis in healthy men. Use of a higher dose of Nal-Glu, a lower dose of T, delaying the start of T replacement until several weeks after Nal-Glu injections are initiated, or prolonged hormonal administration might lead to a combination regimen that will suppress spermatogenesis more fully than does T alone.

Adult↗
PubMed1992

Induction of azoospermia in normal men with combined Nal-Glu gonadotropin-releasing hormone antagonist and testosterone enanthate.

The effects of a combined GnRH antagonist and testosterone (T) replacement regimen on gonadotropins and spermatogenesis were examined to assess its potential as a male contraceptive regimen. The potent Nal-Glu GnRH antagonist ([Ac-D2-Nal1,D4-Cl-Phe2,D3-Pal3,Arg5, D4-p-methoxybenzoyl-2-amino butyric acid6,D-Ala10]GnRH) was administered daily (7.5 mg, sc) to eight normal men for 16 weeks. T enanthate was given im starting at week 2 and every 2 weeks thereafter through week 14 of the treatment phase. Serum LH, FSH, T, and estradiol concentrations were measured frequently during the 5-week control period, the 16-week treatment phase, and the 14-week recovery phase. Semen analyses were performed every week during the control phase and every 2 weeks during the treatment and recovery phases. Seven of eight subjects became azoospermic by 6-10 weeks of treatment; the eighth subject, who failed to achieve azoospermia, suppressed his sperm count to 7 million/mL by week 14 (from a mean baseline of 42 million/mL) before treatment was prematurely terminated because of localized swelling at each of his injection sites. Sperm counts returned to baseline 10-14 weeks after the end of Nal-Glu administration. Seven of the eight subjects showed suppression of LH to the limit of assay detection (less than 0.2 U/L), whereas the eighth subject showed incomplete suppression. Serum bioactive and immunoreactive LH concentrations showed concordant responses. Mean serum FSH concentrations were also markedly suppressed. Serum T and estradiol concentrations declined dramatically during the first 2 weeks of Nal-Glu GnRH treatment, but returned to the normal physiological range after T enanthate replacement was initiated. Libido and sexual potency were maintained. No systemic side-effects, other than erythema and induration at injection sites, were observed. These data demonstrate that combined GnRH antagonist plus T treatment can predictably and reversibly induce azoospermia in most men and has potential as a male contraceptive regimen.

Adult↗