Prognostic value of the heterologous ovum penetration test for human in vitro fertilization.

In order to evaluate the prognostic value of the heterologous ovum penetration test (HOP-test) the results of this test were compared with the fertilization rate of human ova in a programme for in vitro fertilization and embryo transfer (IVF/ET). Sperm from 29 husbands (23 normozoospermic and 6 with an abnormal semen profile) were exposed on one occasion to approximately 30 hamster ova in the HOP-test and on 1 to 3 occasions to 1 to 4 preovulatory oocytes obtained from the respective wives. The mean penetration rate (+/- SEM) of the hamster ova was 43 +/- 4% (range: 0-62%) for the normozoospermic men, and 23 +/- 6% (range: 0-47%) for the men with abnormal semen profiles. In 20 out of 23 couples in which the husbands were normozoospermic, sperm penetrated the hamster ova as well as they fertilized human ova; however, in one couple, a false-positive result was obtained (penetration of the hamster ova and no fertilization of the human oocytes) and in one couple a false-negative result occurred. One negative IVF result was correctly predicted by the HOP-test. In the 6 patients with disturbed sperm motility no correct positive or negative results were obtained, whilst 4 false-positive and 2 false-negative results occurred using the HOP-test. Although the number of patients with disturbed sperm motility was small, the data suggest that the HOP-test is of limited value in predicting fertility in an IVF program for couples with reduced fertility.

Male infertility: relationships among gonadotropins, sex steroids, seminal parameters, and personality attitudes.

We investigated the relationship between objective psychologic test data and endocrine parameters as well as ejaculate characteristics in 117 husbands in barren couples. Data analysis suggests that test scores indicating high self-confidence, extraversion, and social assertiveness correspond negatively with male fertility parameters. Our results show that levels of gonadotropins and sex steroids, as well as accessory gland functions, are not randomly related to personality attitudes in these patients, but support the idea that psychologic factors are relevant in male infertility.

Psychobiological profiles in infertile men.

To investigate the psychosomatic impact in male infertility, we analysed relationships among psychological (life events, personality attitudes) and biological (gonadotrophins, sex steroids, seminal parameters) variables in 101 husbands of barren couples. In patients with subnormal fertility parameters, personality attitudes were not different from those of a reference group of the questionnaire (FAPK) used in this study. However, patients with high scores on test scales such as regression, hypochondria, or emotional vacuity showed better fertility characteristics. These results agree with previously reported data, suggesting that social assertiveness and extraversion but not introversion and depression are associated with male infertility.

Suppression of pituitary and testicular function in normal men by constant gonadotropin-releasing hormone agonist infusion.

In a trial for male fertility control the effects of constant GnRH agonist (buserelin) infusion on pituitary and testicular function was investigated. The agonist was administered sc for 12 weeks to two groups of normal young men using extracorporeal osmotic minipumps. Seven men received 118 +/- 24 (SD) micrograms/day from pumps changed biweekly and four men received 230 +/- 27 micrograms/day from pumps changed weekly. After an initial rise serum LH, FSH, and testosterone decreased. The decrease occurred faster in the high dose group and these subjects had no LH response to acute GnRH stimulation after 4 weeks of treatment, whereas the response was drastically reduced in the group receiving the low dose. Androgen substitution with testosterone undecanoate (80-120 mg orally daily) was initiated when the subjects complained of decreased libido and/or potency or when serum testosterone fell below 10 nmol/liter on average in the fifth week. Sperm counts decreased significantly and below the lower normal limit of 20,000,000/ml. The nadir was reached in week 12 of treatment in the high dose group, and in week 4 post treatment in the low dose group. Despite desensitization of the pituitary and impaired testicular function azoospermia did not occur. A higher dose of agonist appears to be required to achieve this goal.

The lack of discriminant seminal and endocrine variables in the partners of fertile and infertile women.

Seminal and endocrinological investigations were done on 50 fertile men whose wives became pregnant spontaneously (Group I), on 100 men from our fertility clinic whose wives conceived after treatment of the couple (Group II) and in 100 infertile men whose wives failed to become pregnant even after 5-year treatment of the couple (Group III). Patients with azoospermia were excluded. While there were no significant differences in the mean sperm density and total sperm count of the men from all three groups, mean sperm motility and sperm morphology were significantly better (p less than 0.001) in both Group I and Group II men than in the infertile Group III men. The mean serum LH and FSH concentrations were significantly lower in Group I than in the two other groups. However, there were no differences between Groups II and III. The mean serum concentrations of prolactin, testosterone, and estradiol were similar in all three groups. Based on semen and hormone data, stepwise multiple discriminant analysis could allocate 80% of the Group I men correctly, whereas only 50% of Groups II and III could be correctly classified. Although overall differences in sperm motility and morphology as well as in serum gonadotrophin concentrations were noted, no specific seminal or hormonal variable could be identified as being of value in predicting the fertility of an individual man.

[Pregnancy after treatment of ejaculate with alpha-chymotripsine because of failure to liquefy]. / Schwangerschaft nach Behandlung des Ejakulates mit alpha-Chymotrypsin wegen fehlender Liquefizierung.

Failure of the human ejaculate to liquefy can be the cause of infertility. We report one such case in which liquefaction of the coagulated ejaculate was effected by alpha-chymotrypsin in-vitro and led to pregnancy after homologous in semination.

Heterologous ovum penetration test and seminal parameters in fertile and infertile men.

Sperm penetration rates in the heterologous ovum penetration test were correlated with results of routine semen analysis in 30 fertile and 50 infertile men. There was no difference in penetration rates when comparing infertile men with normal and abnormal seminal parameters, nor was any difference seen between fertile (15-83%) and infertile men (8-83%). Of the 22 infertile men with normal seminal characteristics, seven had partners with no discernible reproductive dysfunction. The penetration rates of these men (38-81%) did not differ from those of fertile men. Stepwise regression analysis of seminal characteristics, with penetration as the dependent variable, indicated that sperm count and morphology are the most important seminal parameters for fertility assessment. Discrimination analysis revealed that sperm numbers and morphologic variables provide significant information for discriminating between fertile men and infertile men with normal or abnormal seminal characteristics. Sperm penetration and motility were not indicated as important factors. The present data suggest that, in unselected male patients seeking reproductive evaluation, the sperm penetration assay did not yield any additional information on the cause of infertility.

Saliva and serum testosterone following oral testosterone undecanoate administration in normal and hypogonadal men.

Since saliva testosterone reflects the testosterone fraction available to target tissues the therapeutic effectiveness of orally administered testosterone undecanoate was assessed by measuring testosterone in serum and saliva. Matched saliva and serum samples were obtained from 12 normal men and 8 hypogonadal men before and at hourly intervals after the oral administration of 120 mg testosterone undecanoate. The test was repeated in 3 men after they had taken 40 mg testosterone undecanoate twice daily for 4 to 5 weeks. Following testosterone undecanoate administration serum and saliva testosterone always showed parallel increases. However, the absorption curves showed a high interindividual variability in the time when maximum concentrations were reached, as well as in the maximum levels themselves. The increases in serum and saliva testosterone were similar in normal and hypogonadal men. In normal men basal levels were reached 4 h after the maximum had occurred, while in hypogonadal men testosterone levels were not different from basal levels 2 h after the maximum. The study shows that testosterone undecanoate is well absorbed from the gut and releases significantly elevated amounts of testosterone which is available to target tissues. As the absorption pattern was always parallel in both fluids, hydrolysis of the circulating testosterone ester by the tissue itself seems to effect no additional increase of testosterone in the tissue.

Reproductive functions in young fathers and grandfathers.

Testicular functions were investigated in 23 grandfathers [60--88 yr old; 67 +/- 7.8 (mean +/- SD)], i.e. men with fertility proven earlier in life. They were recruited from a nonpatient population and led an active life, most of them with a permanent partner. The grandfathers were compared with a group of 20 unrelated healthy fathers, 24--37 years old (29.2 +/- 3.2). Whereas sperm density was higher in the older group, there were no significant differences in ejaculate volume and sperm morphology between the younger and older men. Sperm motility and seminal fructose, however, decreased with age. The fertilizing capacity of sperm as assessed in the heterologous ovum penetration test using zona pellucida-free hamster eggs did not decrease significantly with age. Whereas the basal serum testosterone and estradiol levels were not different between the younger and older men, the response to 2 days of hCG stimulation decreased significantly with age. This decrease was observed in older men whether they had frequent or infrequent sexual activity. Basal serum LH and FSH levels were elevated in the older men. The LH response to GnRH stimulation relative to basal; values was significantly reduce, while FSH responses did not change with age. We conclude that sperm counts and fertilizing capacity of sperm are not negatively influenced by old age, at least not in men with sustained sexual activity. However, the pituitary as well as the testis show signs of decreased endocrine reserve capacity in old age.

[Characteristics of male fertility (author's transl)]. / Charakteristika der Fertilität des Mannes.

Gynaecological and andrological investigation results were analysed in 100 childless couples attending a fertility clinic and where the women finally became pregnant. It was shown that there were no discriminating normal values of the ejaculate distinguishing male fertility and infertility, with the exception of azoospermia. One should rather speak of increased chances due to improvement in sperm count and quality. On the other hand, serum FSH concentration is a sensitive indicator of male fertility and was under 4 micrograms/l in 90% of all fathers. Reproductive functions of the women are of importance for male fertility inasmuch as with an optimal female cycle conception may occur even with unsatisfactory ejaculate.