Is there increased fertility in adult males with the sickle cell trait?

Different proposals have been offered to explain the polymorphism of the sickle cell hemoglobin gene. One of these proposals (Eaton and Mucha 1971) suggested that differential fertility of male subjects with the sickle cell trait contributes to the persistence and stability of the sickle cell gene frequency. Eaton and Mucha claimed that oligospermia, induced by hyperpyrexia, is a less common problem in these subjects because they probably have milder and shorter episodes of fever from malaria infection than subjects with a normal genotype. We have looked for evidence to support this hypothesis by comparing the testicular function, testicular size, and serum concentrations of the reproductive hormones in adult male subjects with the sickle cell trait and in an age-matched group of subjects with normal hemoglobin genotype. The mean serum concentration of testosterone, luteinizing hormone, follicle-stimulating hormone, and prolactin of both groups, measured by radio-immunoassay, were not statistically different from each other. Also, there was no detectable difference in any of the common indexes of semen quality between the two groups. The testicular volume index and several anthropometric indexes of subjects with the sickle cell trait and subjects with the normal hemoglobin genotype were also statistically similar. The results suggest that gonadal function is similar in adult males with the normal genotype and those with the sickle cell trait. Any increase in fertility observed in the latter group is probably due to extragonadal factors.

Local anaesthetic on Filshie clips for pain relief after tubal sterilisation: a randomised double-blind controlled trial.

Pain during tubal sterilisation is thought to be due to either ischaemia or pressure at the site of impact of sterilising devices on the fallopian tubes. We have evaluated the effectiveness of an application of 2% lignocaine gel to Filshie clips to relieve postoperative pain. In a randomised double-blind placebo-controlled study, 80 healthy women undergoing tubal sterilisation under general anaesthesia at the County Hospital, Lincoln, UK, were allocated to be sterilised by Flishie clips covered with 2% lignocaine gel or K-Y gel as placebo. Pelvic pain was assessed, with a 100 mm visual analogue scale, at 1 hour, at hospital discharge, and time of first analgesia or any other time analgesia was demanded. The lignocaine-treated group had significantly longer time to first analgesia, less pain at 1 hour, less nausea and vomiting, and shorter recovery time. Fewer lignocaine-treated patients needed additional analgesia and they required fewer opioids. There was no case of failed sterilisation or adverse reaction to lignocaine. The application of local anaesthetic gel to Filshie clips is a safe, non-invasive, and effective method of relieving postoperative pain during laparoscopic tubal sterilisation.

Effect of age on testicular function in adult males with sickle cell anemia.

OBJECTIVES: To determine the effect of age on testicular function and fertility profile of adult males with homozygous sickle cell disease. DESIGN: A comparative cross-sectional study. SETTING: A university teaching hospital in Nigeria. PARTICIPANTS: Twenty-two adult males with homozygous sickle cell disease and 20 healthy adult males with normal hemoglobin genotype. MAIN OUTCOME MEASURES: Seminal indexes, serum concentration of reproductive hormones, body mass index (BMI), testicular volume index, and span-height difference of patients with homozygous sickle cell disease and normal subjects were compared. Also significant differences were sought between two age groups among patients and control subjects: those < or = 25 years old and those > 25 years of age. RESULTS: The mean BMI, testicular volume index, serum T concentration, and indexes of semen quality of the patients with homozygous sickle cell disease were significantly lower than the values for the control subjects. In contrast, there was no significant difference in the mean concentration of FSH, LH, PRL, and mean span-height difference between both groups. Also, although no significant age-related effect on serum T concentration, testicular volume index, and sperm density was found in the subjects 18 to 40 years of age with normal hemoglobin genotype, patients > 25 years old with homozygous sickle cell disease had significantly higher mean serum T concentration and mean testicular volume index than those < or = 25 years old; their sperm density was also substantially higher. CONCLUSION: Fertility is impaired in adult males with homozygous sickle cell disease probably as a result of abnormal hypothalamic or pituitary function. There is a significant amelioration of the hypogonadism, abnormal sexual function, and poor semen profile with increasing age.