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Objective: The objective of this retrospective study of male patients with hypogonadotrophic hypogonadism (HH) was to assess the outcome of fertility after induction of spermatogenesis by gonadotrophin injections., Methods: During 1995-2005 17 men with HH were referred to our department for gonadotrophin treatment to stimulate spermatogenesis., Results: Genetic/idiopathic hypogonadotrophic hypogonadism (IHH) was the most common cause (n = 10) followed by post-operative pituitary failure in three cases. In genetic/IHH, 5 out of 10 cases were born in the Middle East. Gonadotrophin injections induced spermatogenesis in 12 out of 13 HH men indicated by presence of ejaculated motile spermatozoa. All men with proved spermatogenesis and a paternity desire became fathers, five through assisted reproduction with intracytoplasmic sperm injection. A total of 16 children were born as a result of gonadotrophin therapy. Three spontaneously conceived singletons and two twin couples after assisted reproduction were born preterm. Two children from two separate dichorionic twin couples were diagnosed with congenital malformations., Conclusions: Gonadotrophin therapy is successful for men with HH aiming to initiate or re-establish spermatogenesis. Despite low sperm output in some of these men, the rate of pregnancies both spontaneous and after assisted reproduction, was high. More children than expected were born preterm.

There have been numerous inconclusive studies examining the differences between unexplained and peritoneal endometriosis-associated infertility. Hence, the choice of artificial reproductive technique may be difficult. This prospective study compares outcome in couples with unexplained infertility and with minimal or mild endometriosis-associated infertility, undergoing treatment with ovarian stimulation combined with artificial insemination by husband. No differences were found between the unexplained infertile and the endometriosis group as to patient characteristics, response to ovarian stimulation and semen qualities. There was a significantly higher total pregnancy rate, with more multiple gestations, in the unexplained infertile compared with the endometriosis group. The difference in outcome could reflect differences in pathogenesis and aetiology for the two groups.

Human seminal plasma stimulated the progressive motility of human sperm in a dose- and time-related manner. Serum exhibited a similar capacity for stimulation. Seminal plasma from different normozoospermic men showed marked variation in its capacity to stimulate sperm motility. The stimulatory effect was maintained after heat-treatment, indicating the action of a low molecular weight substance or metal ion. No differences could be observed in the capacity for stimulation between seminal plasma from normozoospermic (n = 23) and asthenozoospermic (n = 22) men, when tested at the same dilution and under identical conditions. It is concluded that in general, differences in seminal plasma composition cannot account for the reduced sperm motility in asthenozoospermic men. Furthermore, the stimulatory effects of seminal plasma may be a property shared by other biological fluids.

Embryo intrafallopian transfer was accomplished in 10 patients. Approximately 48 hours after oocyte retrieval, the embryonic cleavage stage was evaluated and from two to six embryos were transferred to the fallopian tubes at the 2- to 8-cell stage using a laparoscopic technique. Five clinical pregnancies resulted; four patients have given birth to five healthy babies (one set of twins) and one had a miscarriage. These results are encouraging, and we believe that transfer of embryos to the fallopian tubes may be an alternative to GIFT or IVF treatment in selected groups of patients.

Determinations of fructose, zinc, magnesium and acid phosphatase were performed in seminal plasma from male partners in 225 barren couples. No specific changes in the concentrations of these substances could be observed in men showing either visible or palpatory abnormalities of the external genitals, the prostate or of the seminal vesicles, extreme changes in the number, morphology or motility of the sperms, increased sperm antibody titre or abnormal serum levels of testosterone or gonadotrophins. However, when the prostatic fluid contained numerous leukocytes, the concentrations of zinc, magnesium and acid phosphatase were significantly lower than in men having a cytologically normal prostatic fluid. Determinations of these substances may thus be of aid in the diagnosis of chronic prostatovesiculitis.

DNA flow cytometry was applied to fine-needle aspiration biopsy specimens from the testes of 20 oligospermic or azoospermic men under investigation for infertility. All aspirations gave sufficient material for DNA flow cytometry, and no complications occurred after aspiration. In both groups many DNA patterns deviated from those observed in control specimens. In general, abnormally small testes were associated with the greatest deviations in DNA patterns. In specimens from certain azoospermic men the DNA distributions did not deviate from those of control samples, suggesting a block in the testicular excurrent ducts. These findings also suggest that DNA flow cytometry of aspirated testicular material can be used in the classification of tubular degeneration in males. The results are obtained within a short time, are quantitative and without bias, and the aspiration causes only little discomfort to the patient. The method can therefore be recommended as a very practical means of obtaining quantitative estimates of spermatogenesis in men being evaluated for infertility.

Studies of the adenylyl cyclase in spermatozoa from 10 asthenozoospermic and 10 normal men revealed major differences with regard to the activation of the enzyme by various drugs and metal ions. While the response to acetate ions was normal, activation of the enzyme by forskolin and the GTP analogue [Gpp(NH)p] was uniformly impaired. In addition, in 4 of the patients the ratios of the Mn2+- and Mg2+-dependent activities of the enzyme were significantly higher than normal, suggesting a delay in the transformation of the enzymes catalytic unit from the soluble to the membrane-bound form. No differences could be recorded in a variety of seminal plasma components including prostatic acid phosphatase, citric acid, zinc, putrescine, spermidine, spermine, fructose, prostaglandin E, and testosterone. Furthermore, the DNA fluorescence patterns of the spermatozoa measured by flow cytometry were within the range of control variations, suggesting that chromatin condensation, and thus nuclear maturation, proceeded normally. The study suggests that a lesion in the adenylyl cyclase system of the germ cells may explain at least some of the motility disturbances seen in infertile males.

The present study entails clinical evaluation of 77 infertile men with testicular descent disturbances. The results summarize as follows: The incidence of disturbance in testicular descent among infertile men was 15.5%, 15.5% and 4.9% in azoo-, oligozoo- (less than or equal to 10 mill/ml) and normozoo- (greater than 10 mill/ml) spermia, respectively. Out of the 77 men investigated, 50 had a history of true cryptorchidism and 27 retractile testes. 31 of the patients with cryptorchidism had previously been subjected to orchidopexy. In the group of infertile men with a history of retractile testes, 20 subjects still retained palpable pathological changes of the testes. Testicular biopsies (from men with retractile testes and sperm count below 10 mill/ml) demonstrated hypospermatogenesis (germ cell arrest to aplasia). 6) 53% of the subjects exhibited elevated serum FSH. Two men had developed testis tumours (seminoma/teratoma). It is advocated that early hormonal therapy and/or surgical procedures should be initiated in an attempt to improve the chances of future fertility both in cryptorchidism and retractile testes.

Sperm analysis and serum hormone measurements (LH, FSH, testosterone) were performed in 29 patients after orchiectomy for seminoma before and after irradiation. Before radiotherapy 14 of 20 orchiectomized patients were azoospermic or had impaired spermatogenesis. A minimum sperm count was found 1 year after radiotherapy with gradual improvement up to 2 years. The recovery of sperm cell production was impaired most in patients with pre-treatment sperm counts less than 3 million/ml. Serum testosterone remained at low normal levels throughout the observation period. The mean serum FSH was increased 1 year after radiotherapy but returned to normal in 50% of patients within 3 years after treatment. This post-treatment increase in FSH was significantly correlated with increased pre-treatment FSH but not with the gonadal dose, which was 1 to 3% of the target dose. Severe disturbances in spermatogenesis, observed 2 to 3 years after radiotherapy for early seminoma, are likely to be the expression of a highly impaired pre-treatment sperm cell production and only to a lesser degree dependent on the irradiation of the remaining testicle.

Three hundred sixty infertile men with sperm counts below 10 million/ml have been through a complete clinical investigation. The most important etiological factors are discussed and the findings at the clinical examination of the genitalia externa and prostate/seminal vesicles are reported. Unilateral or bilateral small and/or soft testes were present in about 60% of the cases. The highest incidence of abnormalities at the examination of the genitals is in conformity with the poor semen qualities. About 50% of the patients had abnormal elevated follicle stimulating hormone (FSH) serum levels, indicating severe functional disorders in the germinal epithelium. Proper treatment is hardly available among these men, but it is important that, where possible, prophylactic measures are taken to avoid the condition developing.