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PubMed1990

Clinical and biological significance of carcinoma in situ of the testis.

Carcinoma in situ (CIS) of the testis is a preinvasive lesion that with time progresses into invasive germ cell tumour. CIS precedes all types of germ cell tumours except spermatocytic seminoma. An increased risk of harbouring CIS has been reported in men with a history of cryptorchidism, in contralateral testes of men previously treated for unilateral germ cell tumour, in intersex patients, in men with assumed extragonadal germ cell tumour and possibly in infertile men. CIS develops into invasive germ cell cancer in 50% of untreated patients within five years of diagnosis, and it is believed that with time CIS will progress into germ cell cancer in almost all patients. A testicular biopsy is necessary to diagnose CIS. Cells with the characteristics of CIS cells have been detected in seminal fluid, and it may be possible to develop methods for diagnosing the condition by analysis of the semen. We recommend orchidectomy as the treatment of choice in cases of unilateral CIS, if the other testis has a potential for fertility. In other cases, such as patients with testicular tumour and CIS of the contralateral testis, we recommend localized irradiation of the testis with CIS. Leydig cell function seems to be slightly impaired, but sufficient for sexual function, after irradiation. CIS cells show morphological and immunohistochemical similarities with primordial germ cells (gonocytes), whereas they share only few features with spermatogonia. Therefore, we suggest that CIS cells are malignant cells derived from gonocytes during embryonic development.

Carcinoma in Situ↗
PubMed1991

Cytogenetic studies in male infertility: a review.

Among those factors known to influence spermatogenesis, chromosomal aberration is perhaps the best known. A review of the literature on mitotic studies in infertile men showed that 12% of the azoospermic and severe oligozoospermic (sperm count less than 10 x 10(6)/ml) males had a karyotypic abnormality; they mainly consisted of an XXY constitution or a Robertsonian or reciprocal translocation. A similar review on meiotic studies revealed that 8% of the infertile males had some kind of cytogenetic error. Therefore, mitotic and meiotic studies are indicated in males with severe gamete impairment when the other possible causes have been eliminated.

Chromosome Aberrations↗
PubMed1977

[Dynamic tests with GnRH, L-dopa, clomiphene, cyclophenyl, HCG and HMG in 98 cases of dysspermia due to a variety of causes].

Radioimmunological methods have been used to assay the plasma concentrations of gonadotropins, androgens (expressed as the sum of testosterone and dihydrotestosterone) and 17beta-oestradiol in 98 patients suffering from dysspermia of variable etiology, after stimulation with GnRH, Clomiphene, L-Dopa, Cyclophenyl, HCG in various dosage schemes, and HMG. Results show L-Dopa and HMG tests to be of little value in assessing the endocrine function in infertile men. They also confirm, in keeping with data found in the literature the usefulness of dynamic stimulation with GnRH, Clomiphene, and HCG for purposes of andrologic diagnosis. The GnRH proved useful for the distinction between primary and secondary hypogonadotropism as well as for assessing the therapeutic efficacy of releasing factors. The functional efficacy of the endocrine axis which is often impaired in patients with dysspermia can be evaluated by the Clomiphene test. In the small number of cases in which it was applied, Cyclophenyl brought about changes in gonadotropin concentration which require further study. The HCG tests, to be performed in patients with lower than normal testosterone plasma lavels, permits the discrimination between primary and secondary Leydig cell deficiencies as well as the assessment of interstitial tissue sensitivity to chorionic gonadotropin stimulation. Of the three dosage schemes (5000 IU, 7500 IU "step up", 10.000 IU) the last one is most suitable for clinical use.

Adult↗
PubMed1978

Immunology and male infertility.

This article has attempted to review evidence that suggests that immune factors may be operative in a small but significant number of infertile men. Although our current understanding of the possible processes by which autosensitization to previously sequestered reproductive antigens occurs is incomplete, there are laboratory assays presently available that give an indication, but do not prove, that immune factors may be contributing to the infertile state. Continued research is needed to develop new assays and more purified sperm antigens, which might enhance our knowledge of the underlying immunoreproductive changes. Until these are available, the following procedures should be considered when investigating a patient with infertility of suspected immune origin. The patient's history should be taken, and a physical examination should be performed. A complete blood count, urinalysis, and complete semen analysis and culture should be taken. Next, in vivo cervical tests (Sims-Huhner) are performed, followed by sperm antibody assessment (serum, semen) and perhaps in vitro cervical mucus sperm assays (especially the crossed hostility test). After the tests have been completed, the following possibe treatments exist: 1. Treatment of underlying infections 2. Correction of obstructions 3. Corticosteroid (or testosterone?) therapy 4. Washed sperm insemination 5. First portion of fresh ejaculate insemination 6. Artificial insemination with homologous donor 7. Adoption.

Agglutination Tests↗
PubMed1979

Immunity and male infertility.

This article has attempted to review evidence which suggests that immune factors may be operative in a small but significant number of infertile men. Although our current understanding of the possible processes by which autosensitization to previously sequestered reproductive antigens occurs is incomplete, there are laboratory assays presently available that indicate, but do not prove, that immune factors may be contributing to the infertile state. Continued research is needed to develop new assays and materials (especially purified sperm antigens) which might enhance our knowledge of the underlying immunoreproductive changes. Until these are available the outline below might be considered when investigating a patient with infertility of suspected immune origin.

Animals↗
PubMed1979

Carcinoma-in-situ of testis in testicular feminization syndrome.

A light microscopical study of an excised testis from a 14 1/2-year-old girl with incomplete type of testicular feminization syndrome revealed a carcinoma-in-situ pattern in a part of the gonad. An identical histological pattern has repeatedly been demonstrated in infertile men who developed gross testicular germ cell tumours. It is suggested that germ cell carcinomas in patients with testicular feminization syndrome may be preceded by this characteristic intratubular germ cell abnormality.

Adolescent↗
PubMed1975

On round-headed human spermatozoa.

In an infertile man and his only, likewise infertile, brother the sperm contained only round-headed spermatozoa. Electron microscopic examination of embedded ejaculate revealed a malformation, viz. absence of acrosomes in all the spermatozoa with consequent lack of normal development of the heads of the spermatozoa. Acrosomeless spermatozoa were also found in the testicular tubuli. No disturbance of the endocrine functions could be demonstrated. The blood cells were of normal male karyotype. Investigation of meiosis, on the other hand, showed rudimentary second division. Two other unrelated infertile men showed the same isolated disturbance in their spermiogram. Treatment with chlomiphene had no effect on the structure of the spermatozoa or on the infertility. The rare disorder, which seems to be a special syndrome, the first hitherto distinguishable among the various types of teratospermia, and its probable background are discussed.

Acrosome↗
PubMed1979

Leydig cell density and function and their relation to gonadotropins in infertile oligospermic men with varicocele.

Circulating gonadotropin and testosterone levels in infertile men with varicocele and sperm counts of less than 10(7)/ml were correlated with testicular Leydig cell density and in vitro testosterone synthesis. A significant correlation was found between Leydig cell density and both plasma testosterone levels and in vitro testosterone synthesis. Luteinizing hormone (LH) levels paralleled the in vitro testosterone synthesis. Although in the majority of patients, in vitro testosterone synthesis and Leydig cell density were low, plasma testosterone and LH levels were within the normal range. The only abnormal circulating hormonal level was high follicle-stimulating hormone in the most severely oligospermic patients. No difference were found between the right and left testes with regard to in vitro testosterone synthesis or Leydig cell density, and no correlation with patient age or site or degree of varicocele could be demonstrated. These findings suggest that Leydig cell dysfunction was the mechanism responsible for the oligospermia and infertility of these patients.

Adult↗
PubMed1979

Improvement of semen and pregnancy rate after ligation and division of the internal spermatic vein: fact or fiction?

Male partners with left-sided varicoceles of 96 infertile couples were studied. Fifty-one patients were submitted to ligation of the testicular veins and 45 individuals were randomised as controls. During an observation period of 53 months (range 36 to 74 months) we found no statiscally significant improvement in the semen crude variables, the morphology or the progressive motility in the series of men submitted to surgery. The pregnancy rate was lower in those who had an excision of varicocelle.

Adult↗
PubMed1978

Value of a testicular biopsy rating for prognosis in oligozoospermia.

Testicular biopsies of 142 oligozoospermic men were used to obtain a testicular biopsy score count. These scores were clearly related to the chance of fertility, in contra-distinction to data on hormone concentrations and from analysis of semen. In 36 patients with a score of 9-10 there were 15 pregnancies; in 59 patients with a score of 8-9, 12; and in 47 patients with scores below 8 there was only one successful pregnancy, though this last group also contained an additional three patients whose wives' pregnancies ended in miscarriages. Rating of testicular biopsies is more useful for proper evaluation of oligozoospermic patients than are data on hormone concentrations and from semen analysis. Proper evaluation of new treatments should be based on trials where experimental and control groups are matched on these ratings.

Biopsy↗
PubMedDate not supplied

Seminal estrone, estrone sulfate, and estradiol-17 beta levels in fertile and infertile males.

The seminal levels of estrone (E1), estrone sulphate (E1S), and estradiol-17 beta (E2) were measured simultaneously after a chromatographic step in the semen samples of 79 men, including fertile volunteers, vasectomized subjects, and patients with oligozoospermia and secretory azoospermia. E1S concentrations in seminal plasma were higher than in serum (with a semen/serum ratio of approximately 2). Seminal E1 and E1S levels in oligozoospermic subjects were significantly decreased compared to controls (p less than 0.02 and p less than 0.03, respectively). The seminal E1S concentration was significantly reduced in azoospermic patients (p less than 0.02) and to a greater extent in vasectomized subjects (p less than 0.001). As seminal E1S is likely to be mainly of testicular origin, the decreased seminal E1S levels in oligoazoospermia are an index of impaired testicular function.

Estradiol↗
PubMed1977

[Examination of male sterility].

There is a description of the main principles for the exploration of male fertility and the evaluation of the results thus obtained. In spermiological investigation the importance of an objective evaluation of sperm motility is emphasized. There is a well-arranged outline of the lower standard limits and the average spermiological values in ejaculates of normal fertile men as well as the nomenclature, both the one used in Prague Institute of Sexology and the suggestion of the international nomenclature given by the Andrology Club.

Humans↗