Relationship between spermatogenesis and serum gonadotropin levels in azoospermia and oligospermia

Possible significance of transferrin levels in seminal plasma of fertile and infertile men

Human seminal plasma contains large amounts of transferrin, which is a protein secreted mostly by Sertoli cells. It has been suggested that the concentration of transferrin may serve as a possible clinical marker of Sertoli cell function. Therefore the concentration of this protein in human seminal plasma from fertile and infertile men has been evaluated in order to find a relationship between transferrin concentrations and human semen parameters and plasma FSH levels. Findings show that seminal transferrin in subjects with oligozoospermia or azoospermia is significantly lower than in controls, and that it is strongly related to sperm count. Results also indicate that transferrin secretion can be impaired when plasma FSH levels are still normal, suggesting that seminal transferrin is an early and specific marker of Sertoli cell function. These results, however, do not clarify whether impairment of transferrin secretion by Sertoli cells is due to an organic dysfunction or to an organic secretory alteration.

Male gonadal function in coeliac disease: III. Pituitary regulation

Pituitary regulation of gonadal function was investigated in 39 consecutive men with treated and untreated coeliac disease and in an intestinal disease control group of 19 men with Crohn's disease of similar age and general nutritional status. Basal serum FSH concentration was increased in 10 of the coeliacs (26%) compared to only two of 19 men with Crohn's disease (11%). This abnormality was observed with equal frequency in both treated and untreated coeliacs, and was not associated with oligospermia. Serum LH concentration was increased in eight of 15 untreated coeliacs (53%) with sub-total villous atrophy, an abnormality which unlike the elevation of serum FSH, appears to return towards normal after gluten withdrawal. Serum LH was high in coeliacs despite marked elevation of the free testosterone index. Exaggerated responses of FSH and LH to LHRH were found in 89% and 45% respectively, of coeliacs with sub-total villous atrophy. However, exaggerated responses of LH alone were found more frequently in coeliacs than in men with Crohn's disease (P less than 0.02) and unlike the exaggerated FSH responses, LH responses were closely related to jejunal morphology. Exaggerated responses of FSH and LH in coeliacs were commonly found when basal gonadotrophin concentrations were normal. The occurrence of exaggerated gonadotrophin responses could not be related to plasma concentration of testosterone, dihydrotestosterone, oestradiol or the free testosterone index. Serum prolactin was modestly raised in 25% of untreated and partially treated coeliacs and in the same proportion of men with Crohn's disease. Elevated serum prolactin concentrations never exceeded 809 mU/l and were not associated with impotence or infertility. This study provides further evidence that in men with coeliac disease there is a derangement of pituitary regulation of gonadal function. This would seem to be part of a wider disturbance of central regulatory mechanisms of endocrine function in coeliac disease.

Frequency of androgen insensitivity in infertile phenotypically normal men

In 1979 Aiman and associates reported on a group of phenotypically normal men with severe oligospermia or azoospermia and androgen receptor deficiency. They calculated an androgen insensitivity index (ng./ml. serum testosterone times mIU/ml. serum luteinizing hormone) to identify these men and found the mean to be 233. We calculated the androgen insensitivity index in 144 infertile male patients in our fertility clinic. Of these patients 86 had azoospermia or severe oligospermia (mean sperm concentration 3 million per ml.). In this group 11.6 per cent had an androgen insensitivity index of more than 200, suggesting androgen insensitivity. These patients were compared to a control group with known fertility (16 semen donors) and to 34 men with idiopathic infertility (mean sperm concentration 47 million per ml.) treated with clomiphene citrate. The androgen insensitivity index may help to identify a group of 10 per cent or more of azoospermic or oligospermic men who are not amenable to therapy.

Variation of semen parameters in fertile men

The spermiograms of 63 fertile men (whose female partners were pregnant at the time of examination) were evaluated. A wide Gaussian distribution of the different semen parameters was found. Both parametric and nonparametric statistical tests were applied and gave almost identical results. In a subgroup of 34 men, a second semen sample was analysed, but a significant difference (p less than or equal to 0.05) between the two samples was found only regarding the proportion of abnormal forms. Between various semen parameters significant correlations were found. There was no association between follicle stimulating hormone (FSH) and sperm density with sperm counts greater than 20 mill/ml.

An examination of blood steroid and gonadotropin concentrations in relation to fertility status and testicular function in men

Plasma concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), testosterone (T), and 17 beta-estradiol (E2) have been measured in men complaining of infertility in comparison with men of proven fertility. Subgrouping of patients was achieved on the basis of the presence or absence of sperm in the ejaculate and further by the concentration of sperm or by testicular score. The levels of plasma LH, FSH, PRL, and T were found to be significantly different in the fertile men, compared with both infertile men with sperm in their ejaculates and azoospermic men. There were no significant differences between the groups for E2. There appeared to be an inverse relationship between LH concentrations and sperm count in both fertile and infertile men. FSH levels did not vary significantly in the fertile men in relation to sperm count grouping but were significantly less than those found for the infertile men with sperm. Azoospermic patients with high testicular scores had FSH levels indistinguishable from those of the fertile men. The results are discussed in terms of testicular abnormalities and on the interrelationship between the hormones examined.

Alteration in the plasma testosterone: estradiol ratio: an alternative to the inhibin hypothesis

The data suggest that in the absence of the testis: (1) testosterone can maintain both FSH and LH concentrations chronically within the physiological range; (2) that estradiol preferentially suppresses plasma LH concentration, indicating that the androgenic component of testosterone modulates FSH secretion; and (3) that subphysiological testosterone concentrations accompanied by physiological estradiol levels permit FSH to escape to midcastrate levels while maintaining LH concentration at intact levels. An alteration in the testosterone: estradiol ratio can account for a selective FSH elevation when testosterone production is low. The data provide an alternative explanation for the inhibin phenomenon.

Effect of cimetidine on gonadal function in man

1 To study the effect of cimetidine on gonadal function in man, eleven male subjects with chronic duodenal ulcer were given cimetidine orally at a dosage of 1000 mg per day 3 months and 400 mg nocte for the subsequent 3 months. 2 Testosterone levels were found to be elevated during therapy when compared to pre- and post-treatment periods. Serum LH remained unchanged but FSH was increased during therapy. In five out of eleven subjects serum PRL levels were increased. Mean sperm count was lower during cimetidine therapy when compared with that after drug withdrawal. The motility and morphology of the spermatozoa were not affected.

The role of testicular biopsy in the investigation of male infertility

Sixty-five testicular biopsies from infertile men were assessed retrospectively. In 21 patients infertility was attributed to varicoceles. In the remaining cases the testicular histology was classified into 3 major groups. Normal, hypospermatogenesis and germ cell aplasia. These histological categories were correlated with serum gonadotrophic hormone levels and sperm counts. All cases of germ cell aplasia showed azoospermia or severe oligospermia, but sperm counts alone were not reliable indicators of spermatogenesis. Patients with very low sperm counts and raised levels of serum FSH invariably had germ cell aplasia. These patients made up a group in whom testicular biopsies were of limited value in assessment. In all other instances the testicular biopsy was still an important tool in the assessment and prognostication for fertility in the subfertile male.

Clinical evaluation of DNA flow cytometry of fine needle aspirates from testes of infertile men

DNA flow cytometry was performed on fine needle aspirates from the testes of 40 oligozoospermic of azoospermic men under investigation for infertility. The DNA distributions from men with increased FSH serum levels were all abnormal. The values were below the level of detection (or very low) with respect to both haploid (1c) and tetraploid (4c) cells, indicating reduced proportions of spermatids and primary spermatocytes. This confirms that increased FSH serum levels are indicative of severely damaged spermatogenesis. The findings of both normal and abnormal testicular DNA distribution in the large group of oligozoospermic men indicate that the presented method may be of importance for evaluating prognosis, and for selection of men for further investigation and therapy. Many azoospermic men showed normal testicular DNA distribution patterns, suggesting the value of DNA flow cytometry for selection of such cases for surgical treatment (epididymovasostomia).

Selective suppression of FSH as a possible approach for fertility regulation

Inhibin can exist in multiple forms. The size heterogeneity of inhibin (low and high molecular weight) is likely to be due to the purification procedures employed. However, irrespective of their size, both inhibin preparations are capable of suppressing circulating FSH levels. Since inhibin is a native hormone, the toxic effects after therapeutic administration are expected to be minimal. Inhibin is able to suppress only 70%-80% of the FSH secretion. Inhibin and the steroid (estrogen or androgen) may be involved in the physiological regulation of FSH. To completely suppress circulating FSH, administration of either a combination of inhibin and a steroid or a potent synthetic analogue of inhibin may be necessary. Inhibin has a very short half life in the adult animal, which may be due to the involvement of other testicular factors. Identification and characterization of these factors may help in prolonging effectiveness of inhibin.

Testicular testosterone concentration, interstitial cell density and spermatogenesis in infertile men

The concentration of testosterone was estimated in testicular biopsies taken from infertile men under general anaesthesia and was found to vary between 0.77 and 9.87 nmol/g wet tissue (median 3.41 nmol/g). Spermatogenesis was assessed by the Johnsen scoring technique but there was no evidence of a deficiency of intratesticular testosterone being associated with dysfunction of the seminiferous tubules. Similarly, there was no direct relationship with testicular size, clinical diagnosis, or the concentration of testosterone found in peripheral plasma taken at the same time as the testicular biopsy. These negative findings were not explained by variation in the volume densities of the Leydig cells assessed in 10 biopsies selected to the representative of the range of testosterone concentrations found in entire series. A retrospective comparison between the concentration of testosterone in peripheral plasma at the time of surgery and the available preoperative levels found in 10 patients provided further evidence for the previously reported lowering of testosterone levels by general anaesthesia. It is suggested that future studies of testicular androgens should be conducted on tissue obtained under local anaesthesia in order to eliminate this effect.

An evaluation of the HCG stimulation test in the investigation of male infertility

Of 159 patients being investigated at the infertility clinic during 1978, 31 agreed to undergo than human chorionic gonadotrophin (HCG) stimulation test. Twenty-one of these patients exhibited varying degrees of oligozoospermia and their response to HCG, measured by a rise in serum testosterone, was not significantly different from that of the remaining patients who had normal sperm counts. Endocrine function of the testes appears to be unaltered even in patients with severely impaired tubular function. It is concluded that assessment of Leydig cell function is of no value in the routine investigation of male fertility.

A comparison of endocrine function and semen analysis in fertile and subfertile men

We studied 122 normozoospermic, 62 oligozoospermic and 22 azoospermic patients and compared serum testosterone, LH and FSH with semen analysis. Testosterone was similar in all three groups studied. FSH rose significantly in the oligozoospermic and azoospermic groups (p less than 0.01). LH was similar in the normozoospermic and oligozoospermic groups but rose significantly in the azoospermic group (p less than 0,01). The rise in FSH is in accordance with the theory of inhibin release during the maturation states of spermatogenesis. The rise in LH might indicate a separate feedback mechanism mediated by the early stages of spermatogenesis and not by testosterone alone.

Endocrine assessment of the subfertile male

Sixty-three male (XY) patients attending a subfertility clinic with average sperm density under 40 million/ml were studied by testicular biopsy and multiple basal estimations of plasma LH, FSH, testosterone as well as LHRH (50 micrograms i.v.) stimulation. A further forty patients with similar sperm densities also had testicular biopsy but only single estimations of the three hormones. A single basal FSH was found to be the best discriminator of testicular histologies. Patients with testicular biopsies showing germ cell aplasia in some or all seminiferous tubules (grades 3 and 4) had significantly higher basal FSH than those with hypospermatogenesis, germ cell arrest or normal appearance (grades 1 and 2). Basal FSH also showed a linear trend rising with decreasing sperm density but only rose above the normal range when sperm densities fell below 1 million/ml. When basal FSH, testicular histology and sperm density were considered together in the whole group (n = 100), high levels of FSH accurately indicated the presence of germ cell aplasia in some or all seminiferous tubules in azoo- and oligospermic men with sperm density under 5 million/ml. Normal FSH and azoospermia is diagnostic of obstruction in the excurrent ducts, and further investigation is undertaken if surgical correction of the obstruction is contemplated. Hormone estimations are not helpful in oligospermic patients with average sperm density over 5 million/ml. On the basis of these findings it is suggested that there is little place for the LHRH test in the routine assessment of male subfertility. Testicular biopsy is indicated only in oligospermic patients with average sperm density under 5 million/ml and normal basal FSH.

Evaluation of the ultrastructural changes in the human sertoli cell in testicular disorders and the relationship of the changes to the levels of serum FSH

Sertoli cell ultrastructure was compared in men with testicular disorders (hypospermatogenesis; germ cell aplasia) and men with normal testes to determine if any specific cytological change could be correlated with diminished feedback from the testis resulting in elevated serum FSH levels. The normal Sertoli cell contained smooth endoplasmic reticulum, mitochondria and variable numbers of lipid inclusions, lipofuscin, crystals of Charcot-Böttcher and specialised inter-Sertoli cell junctional complexes. The principal abnormalities in Sertoli cells of men with testicular disorders were: 1) dilated vesicles of smooth endoplasmic reticulum and occasional expansions of the intercellular space; 2) increased numbers of cytoplasmic filaments; and 3) with germ cell aplasia inter-Sertoli cell junctions were complexly arranged due to interdigitation of Sertoli cell processes. Occasionally, increased lipid and lipofuscin aggregations were seen and in germ cell aplasia, aggregations of cytoplasmic glycogen were often present. Although these changes were seen more consistently with germ cell aplasia they were observed frequently with hypospermatogenesis where some tubules contained Sertoli cells with normal features. No correlation was found between abnormal Sertoli cell cytology and serum FSH levels.

Dibromochloropropane and its effect on testicular function in man

This study represents the largest series to date documenting the gonadotoxic effect in humans of dibromochloropropane, a widely used pesticide. Three semen analyses, serum hormonal determinations (luteinizing hormone, follicle-stimulating hormone and testosterone) as well as genital examinations were completed for 228 workers at 2 chemical production sites and consisting of a dibromochloropropane-exposed and non-exposed cohort. Parameteric and non-parametric statistical analyses of the data sets of the sperm densities from the 2 subpopulations demonstrated statistical significance (p less than 0.10) at the short-term (1.5 years) manufacturing plant. Log transformation of the sperm count and hourly exposure data were necessary to develop meaningful statistical conclusions. The serum concentration of follicle-stimulating hormone as a group mean was significantly greater at both production sites for the exposed cohort when compared to the non-exposed participants but decreased by 10 levels of magnitude when the group demonstraing shorter but more recent exposure was compared to those from the plant with longer chemical production. Finally, a dose-response model suggested significant changes in sperm density at the short-term but more recently operated production site when more than 100 adjusted hours of exposure were exceeded, while the longer operated but longer closed facility demonstrated a significant impairment only when more than 1,000 adjusted hours of dibromochloropropane exposure were surpassed. This difference in exposure data may reflect regenerative changes in the tests once the gonadotoxic substance had been removed but exact nature of the dibromochloropropane effect and the possibility of a "no effect" concentration remain to be defined clearly.

Testicular torsion: late results with special regard to fertility and endocrine function

Late results were determined for 42 patients who had undergone detorsion and fixation for unilateral testicular torsion in the prepubertal and pubertal age. Exocrine and endocrine function for the testes was determined in 30 patients who had reached postpuberal age. Patients who underwent detorsion and fixation 8 hours or less after the onset of symptoms had normal-sized testicles and only slight changes in testicular morphology. When treatment was delayed and detorsion was done more than 8 hours later a marked decrease was observed in testicular size. The exocrine function in patients with torsion was reduced. The semen quality, as judged by 2 semen analyses, was normal in 15 patients, doubtful in 3 and pathological in 12. Even when detorsion was done 4 hours or less after the onset of symptoms the exocrine function of the testes was normal in only 50 per cent of the cases. In patients with doubtful and pathological sperm analyses higher follicle-stimulating and luteinizing hormone levels were observed.

Plasma hormone levels in fertile and infertile Nigerian men

Levels of plasma follicle-stimulating hormone, luteinizing hormone and testosterone in men of proven fertility were compared with those of oligospermic and azoospermic men. The mean level of follicle-stimulating hormone was much higher in the subfertile group, showing a positive association with low sperm count and gonadal histologic defect. The mean level of luteinizing hormone also showed a significant rise with declining sperm density, but no significant statistical difference was observed between the oligospermic and azoospermic patients. Although there was a rise in the mean level of plasma testosterone with poor sperm density, the values were within the normal range. Hormone studies are recommended for investigating male infertility to help delineate men with pregonadal of primary gonadal defects.

Effect of combination chemotherapy on pituitary-gonadal function in patients with lymphoma and leukemia

After at least four courses of intermittent chemotherapy, 14 of the 15 men with malignant lymphoma had elevated serum follicle-stimulating hormone (FSH). In three of these subjects, serial studies showed progressive increases in basal FSH and exaggerated FSH responses to luteinizing hormone releasing hormone (LHRH). Although gonadal biopsies were not done, this elevation of FSH is indicative of progressive and severe damage to the germinal epithelium by chemotherapy. Elevated leutinizing hormone (LH) was found in seven and decreased testosterone (T) in two of these subjects. Increased LH responses to LHRH stimulation were also found in the three subjects studied. These findings suggest that the testicular damage is not restricted to the germinal tissue. In four male subjects with acute myeloid leukemia treated by intermittent chemotherapy not containing any alkylating agents, FSH, LH, and T levels were normal. Three of the 4 female patients with malignant lymphoma and two with acute myeloid leukemia had normal basal, serial, and LHRH-stimulated FSH, LH, and estradiol (E2) levels. Elevated gonadotropins and low E2 were found only in subjects who had received abdominal irradiation.

Investigation of the hormonal axis hypothalamus-pituitary-gonads in 20 dialyzed men. GnRH-test in dialyzed men

20 male patients suffering from end-stage chronic renal failure and maintained on hemodialysis were investigated for pituitary response to GnRH. The GnRH-Test was performed simultaneously with hemodialysis; however, hemodialysis was started 60 min. after the injection of GnRH. Basal values of LH and FSH were significantly higher (P less than 0.0001 and 0.005, respectively) than the normal range, while basal values of testosterone were in the subnormal range or depressed (P less than 0.0001). Poststimulatory values of LH were significantly lower (P less than 0.01) than normal and--other than normal--did not decline within 180 min. following injection of GnRH (P less than 0.001). The same pattern was seen for FSH, however, no statistical significance could be secured. Testosteron was elevated 30 min. after stimulation with GnRH (P less than 0.001).

Evaluation of the treatment with gonadotropic hormones in cases of severe and moderate oligozoospermia

Here are reported results of a study based on the administration during 13 weeks of Pergonal-Profasi, in cases of oligozoospermia. When comparing these data to others obtained previously, conclusion can be drawn that administration of these gonadotropic hormones is mainly indicated to patients showing, on the one hand, oligozoospermia combined, on the other hand, with subnormal FSH-values. Though no investigation was made on this point, it can be expressed that specifically in cases of patients with very low FSH levels a treatment consisting of prolonged administration with higher dosages has to be preferred.

Reappraisal of the value of testicular biopsy in the investigation of infertility

One hundred and forty-two biopsies were reviewed to reappraise the value and indications for testicular biopsy in the investigation of infertility. These biopsies were categorized within the following morphologic patterns: normal, hypospermatogenesis, maturation arrest, Sertoli cell-only syndrome, and Klinefelter's syndrome. The morphology of the biopsies was correlated with the available sperm count, and the contribution of the biopsy to the patient's treatment was assessed. Testicular biopsy has proved most useful in azoospermia for the identification of obstruction. In oligospermia, biopsy appears to be of little use.

Serum and seminal gonadotropins in normal and infertile men: correlations with sperm count, prolactinemia, and seminal prolactin

Serum and seminal gonadotropins were evaluated in 30 normozoospermic and 30 oligozoospermic patients. Mean values of basal serum gonadotropins were higher in the oligozoospermic group than in the normozoospermic group: 3.8 versus 1.8 ng/ml and 3.3 versus 2.2 ng/ml for FSH and LH, respectively. Seminal FSH levels were comparable in the normozoospermic and oligozoospermic groups (0.8 versus 0.8 ng/ml, respectively) and were constantly lower than serum FSH levels in both groups. Seminal LH values were constantly higher than serum LH values in the normozoospermic group, whereas in the oligozoospermic group seminal LH values were higher, similar, or lower than serum LH values. However, no significant difference was noted between the two groups for seminal LH values: 3.6 (normozoospermic group) versus 4.1 ng/ml (oligozoospermic group).

Endocrine studies of azoospermia. I. Serum steroid levels in Sertoli cell only syndrome

Estrone, estradiol, estriol, progesterone, 17 alpha-hydroxyprogesterone, testosterone, and dihydrotestosterone levels were determined in sera of 20 fertile men and 15 male patients with Sertoli cell only syndrome. In men with Sertoli cel only syndrome there was a significant decrease in serum estrone, estradiol, progesterone, 17 alpha-hydroxyprogesterone, and dihydrotestosterone and a significant increase in serum estriol and testosterone. Changes in endocrine profile discussed in relation to the possible role of inhibin.

Serum gonadotropins and testosterone in infertile patients with varicocele

Serum concentrations of gonadotropins and testosterone in 25 infertile men with varicocele were compared with those in control men and men with idiopathic oligo-azoospermia. No significant difference was found in values of serum follicle-stimulating hormone (FSH) (14.9 +/- 13.6 mIU/ml), luteinizing hormone (LH) (24.9 +/- 19.1 mIU/ml), and testosterone (5.0 +/- 2.1 ng/ml) when the group with varicocele was compared with either the control group (FSH, 7.0 +/- 3.2 mIU/ml; LH, 23.6 +/- 16.0 mIU/ml; testosterone, 5.3 +/- 1.8 ng/ml) or the group with idiopathic oligo-azoospermia (FSH, 23.0 +/- 22.69 mIU/ml; LH, 36.7 +/- 24.1 mIU/ml; testosterone, 5.31 +/- 2.3 ng/ml). However, compared with the control group, there was a significant elevation of serum FSH levels in patients with varicocele whose testicular biopsy score counts were between 1 and 4. The importance of preoperative determination of the serum FSH level is discussed.

Releasing factor tests in men with oligozoospermia

FSH levels were assayed in 300 men attending with infertile marriages. From this number, releasing factor tests were carried out in 24 men with oligozoospermia and an initial FSH below our normal mean. In all of these cases there was a response to releasing factor. Isolated FSH deficiency is likely to be rare in adult men presenting with infertility and no previous endocrinological history.

Endocrine studies of azoospermia. II. Serum steroid levels in obstructive azoospermia

Serum estrone, estradiol, estriol, progesterone, 17 alpha-hydroxyprogesterone, and testosterone were determined in the sera of 25 normal males and 25 patients with obstructive azoospermia. An increase in testosterone and estriol levels, and a decrease in other hormones were demonstrated in patients with obstructive azoospermia. These long-term effects of obstruction of the vas apparently also occur in comparable situations, for example, after vasectomy.

Idications for testicular biopsy or exploration in azoospermia

Investigation of 311 azoospermic males has shown that the combination of estimation of testicular size and plasma FSH allows the spermatogenic function of the testes to be accurately assessed by non-invasive methods. Patients with small testes and grossly elevated levels of plasma FSH have absent, or grossly impaired spermatogenesis, and do not require surgical exploration. They should be advised with regard to adoption or artificial insemination. Patients with large testes (5 cm) or an FSH level which is not grossly elevated require operation and should undergo a surgical exploration and the possible correction of an obstructive lesion. A testicular biopsy is essential if no obstructive lesion is found as the histology of these patients may show a spermatogenic arrest.

Testicular function following irradiation of the human prepubertal testis

Testicular function was studied in ten men, aged between 17 and 36 years, who had received irradiation for a nephroblastoma during childhood. The dose of scattered irradiation to the testes ranged from 268 to 983 rad. Eight subjects had either oligo- or azoospermia (0 to 5.6 million/ml), seven of whom had an elevated serum follicle-stimulating hormone (FSH) level. One subject showed evidence of Leydig cell dysfunction with a raised serum luteinizing hormone level (LH) and a low plasma testosterone concentration. A second group of eight prepubertal males, aged between 8 and 14 years, were studied. These had also been irradiated for abdominal malignancies during childhood and received a similar dose of irradiation to the testis as the first group studied. The plasma testosterone levels were within the normal range for prepubertal boys in all eight. The mean gonadotrophin levels were not significantly different from the mean levels of normal prepubertal males. Thus irradiation-induced damage to the germinal epithelium in prepubertal boys produces raised FSH levels after puberty but not before it. We conclude, therefore, that inhibition has a minor role in the control of the prepubertal hypothalamic-pituitary testicular axis and its contribution to gonadal control of gonadotrophin secretion changes with sexual maturation.

The relationship between plasma FSH, testosterone levels and testicular histology in males with azoospermia

The plasma FSH and testosterone levels were determined by the radioimmunological method in 27 men with azoospermia. The plasma FSH levels were elevated in the Sertoli-cell only syndrome and in the case of inhibited spermatogenesis. The plasma FSH level was normal in patients with normal spermatogenesis. The plasma testosterone level did not differ from the normal values in any of the above-mentioned groups of patients.

Endocrine abnormalities associated with chronic renal failure

It is evident that chronic renal failure has far-reaching metabolic consequences because endocrine aberrations are common. Uremia may alter endocrine function through its effect on the hypothalamopituitary axis, the individual end organs, and the peripheral metabolism of various hormones. Deficiency of some hormones and excess of others coexist in patients with renal failure. Since the physiologic effects of many of these abnormalities are still not well defined, no treatment is necessary with the exception of true deficiency states such as testosterone deficiency. In the latter instance, exogenous hormonal supplementation is recommended.

Can follicle stimulating hormone estimation replace testicular biopsy in the diagnosis of obstructive azoospermia?

Sixty azoospermic men were investigated by means of testicular biopsy and estimation of serum follicle stimulating hormone (FSH) levels. High FSH levels when associated with small testes indicated severe testicular damage. We suggest that these findings offer sufficient evidence to regard such patients as infertile and that further investigation is unnecessary. In men with normal FSH levels testicular biopsy is still necessary for accurate diagnosis; in practice this may often be done at the same time as epididymovasostomy.

Measurement of gonadotrophins, testosterone, delta4 androstenedione and dihydrotesterone in idiopathic oligospermia

Basal concentrations of FSH, LH, testosterone, delta4 androstenedione and dihydrotestosterone, together with FSH and LH responses to single injections of LHRH were determined in eighty-four patients with oligospermia and in twenty-seven normal men. LHRH responses were heterogeneous and indicate that various disorders might cause this syndrome. In six cases there appeared to be an isolated deficiency in spermatogenesis, as indicated by an increased FSH response, whilst the LH response was normal as were the concentrations of the testicular hormones. In twenty cases a concomitant disorder of Leydig cell function and spermatogenesis is suggested as indicated by increased FSH and LH responses and decreased concentrations of testosterone and delta4 androstenedione (six) or concentrations at the lower limit of normal (fourteen). Furthermore, in five cases a hypothalamic and/or pituitary disturbance may be accepted on the basis of normal or decreased basal concentrations decreased and responses to LHRH with decreased concentrations of testosterone and delta4 androstenedione. Finally, in thirty-seven cases, oligospermia was not associated with any modification basal gonadotrophin concentrations or response to LHRH when compared with normal subjects.