Fluorescence in situ hybridization is a fast and efficient method of investigating chromosomal abnormalities in human spermatozoa. In this study, we have established the frequency of sex chromosome disomy (XX, XY and YY) in teratozoospermia (98-100% abnormal morphology) of infertile men compared with normospermic men using double-probe FISH procedures. A total of 40,000 sperms were scored in each group of semen for chromosome X and Y with overall hybridization efficiency of 97.00 per cent and 98.02 per cent in infertile men and normal men, respectively. It was found that the frequency of disomy XX, XY and YY was significantly higher in infertile men compared with normal men (P < 0.05). It is concluded that the infertile men showed increased frequencies of sex chromosomal abnormalities.

To evaluate prospectively vaginal bleeding in young children with emphasis on the cause, management and outcome, we analyzed the data of all children aged under 10 years old who presented with vaginal bleeding at the King Chulalongkorn Memorial Hospital between 1981 and 2000. There were 55 girls presenting with vaginal bleeding with variable degrees of severity. In 41 of the 55 girls (74.5%), the bleeding resulted from a local lesion of the genital tract. Genital tumors were seen in four girls, ie hemangioma of the vulva, sarcoma botryoides of the vagina, functional ovarian cyst and granulosa cell tumor of the ovary. In the remaining 14 girls (25.5%), the bleeding originated from systemic hormonal etiology. In one girl with precocious puberty, it was associated with hypothyroidism, whereas in the other six girls it was due to constitutional causes. In addition, the cause of bleeding in 10 girls was the vaginal manifestation of leeches, which is a unique problem for Thailand. Although vaginal bleeding in young children is rare, it can be an alarming clinical presentation, and serious underlying causes should be excluded. Prompt and correct diagnosis will lead to successful management.

Determination of X and Y human spermatozoa by double labelled fluorescence in situ hybridization (FISH) is a new and more reliable method than Quinacrine hydrochloride staining for Y sperm identification. A preliminary report on determination of the ratio of X and Y sperm of normal semen of fifteen donors by double labelled FISH method before and after Y sperm separation by Ericsson albumin column method. This is currently popularized in Thailand. Results of standardized FISH technique has an average success rate of approximately 95 percent. Results of the experiment showed that the ratio of X:Y sperm before and after albumin column filtration is 50.03:49.80 and 48.77:51.00, respectively. Few spermatozoa have double sex chromosomes, XX, XY or YY. In conclusion, Y sperm selection by Ericsson's method is ineffective for male sex preselection.

To investigate the effect of testosterone enanthate on suppression of spermatogenesis in Thai men, 17 normal Thai men were given 200 mg testosterone enanthate weekly by intramuscular injection. During treatment, semen was collected regularly to monitor spermatogenesis. Median times for the first semen sample reaching sperm concentration threshold of 5, 3, 1 and 0 million/ml were 58, 70, 84, and 85, respectively. Subsequently, all men became azoospermic. Among 17 men entering the efficacy phase, 14 (82.3%) achieved consistent azoospermic from the beginning of efficacy phase, the remaining 3 (17.7%) were initially severe oligozoospermic but later became azoospermic. Only one case achieved consistent oligozoospermia but did not achieve azoospermia within 6 months. After stopping injection, sperm first reappeared in the ejaculate of formerly azoospermia men at 73 days. Recovery of sperm output to normal sperm concentration (> 20 million/ml) was achieved by all men at a median time of 3.9 months and recovery to their own baseline in one year after the last injection was established in 13/17 (76.5%) at a median time of 4.9 months, respectively. In conclusion, testosterone enanthate alone is effective in suppression of spermatogenesis for male hormonal contraception due to the high rate of azoospermia induced, which is known to ensure reliable and effective, reversible contraception.

In conclusion, the present study demonstrated that induced severe oligozoospermia or azoospermia by weekly testosterone enanthate injection was sufficient for male contraception. The low rates of discontinuation due to side-effects of the hormone and incidental medical conditions in this study confirms the safety and acceptability of such androgen administration found in studies with up to 18 months exposure. The long-term hazards remain uncertain and require investigation for risk. The possible long-term benefits from androgen use for bone, muscle and blood metabolism will also need to be assessed before the net risk-benefit effects of an androgen-containing regimen can be fully evaluated. In summary, the contraceptive efficacy for male contraception in this study demonstrated that weekly injections of testosterone enanthate can provide safe and effective contraceptive protection. The practicability of this approach may be improved by the use of longer-acting testosterone preparations which are under development.

In summary, there were significant differences in blood and semen lead levels, LH levels and prolactin levels in workmen who were exposed to lead. However, all hormonal profiles still remained within the normal adult range for Thai men. Higher levels of blood lead were found to have no significant effect on the sperm variables and hormonal profiles except testosterone levels at second follow-up and prolactin levels at sixth follow-up. However, these differences were not consistent during the study period. It should be noted that the present data are preliminary, pertain only to short-term exposure and require confirmation. The actual prospective long-term risk of lead exposure, remains to be determined. However, our study highlights the feasibility and importance of a prospective cohort study in assessment of the risk of lead exposure on male reproductive system. Long-term longitudinal controlled studies of semen quality and hormonal profiles in workmen examined before and during lead exposure and prospective studies of time to pregnancy in couples attempting to achieve pregnancy are probably necessary in order to obtain further knowledge. This study also indicates that the reproductive function surveillance of these workmen must be investigated as well as other physical health. In conclusion, an increase of blood lead levels due to occupational exposure cause no immediate and significant changes in spermatogenesis and hormonal profiles.

Objective: To determine contraceptive efficacy of hormonally induced sperm suppression to severe oligozoospermia or azoospermia.Design: Prospective, noncomparative contraceptive efficacy study.Setting: Multicenter study in 15 centers in nine countries.Participants: Three hundred ninety-nine normal, healthy, fertile men requesting a male contraceptive method.Intervention: Weekly IM injection of 200 mg T enanthate.Main Outcome Measure: Incidence of pregnancies in efficacy when couples relied on T injections alone for contraception.Results: Four pregnancies occurred during 49.5 person-years involving men with oligozoospermia (0.1 to 3 x 10(6)/mL) and none during 230.4 person-years in azoospermic men: pregnancy rates 8.1 (95% confidence interval [CI] 2.2 to 20.7) and 0.0 (95% CI, 0.0 to 1.6) per 100 person-years, respectively, or 1.4 (95% CI, 0.4 to 3.7) per 100 person-years for oligozoospermia and azoospermia (0 to 3 x 10(6)/mL) combined. Pregnancy rates were related to sperm concentration. Inadequate suppression of spermatogenesis occurred in eight men and escape from suppression occurred in four. Discontinuations were due to personal reasons (50 men, cumulative annual Life-table rate 12.2% [95% CI, 9.1% to 16.1%]) and dislike of the injection schedule (21 men, 5.1% [95% CI, 3.2% to 7.9%]). Thirty-five men discontinued for medical reasons (9.4% [95% CI, 6.7% to 13.2%]), with no serious treatment-related side effects. After stopping injections, sperm output recovered; additionally, fertility was demonstrated in 33 couples.Conclusion: Suppression of spermatogenesis to azoospermia or severe oligozoospermia (less than or equal to 3 x 10(6)/mL) induced by weekly T enanthate injections results in sustained, reversible contraception with good efficacy and minimal short-term side effects. New hormonal regimens with more convenient delivery and improved spermatogenic suppression would provide practical male contraception.

Two multicentre studies of the contraceptive efficacy of azoospermia and severe oligozoospermia were conducted in 16 centres in 10 countries. They used a common protocol of weekly testosterone injections for sperm suppression, the patterns and degrees of which were compared among men from different population groups. Six hundred and seventy normal, healthy volunteers, of whom 205 were Asian (mostly Chinese) and 465 of non-Asian origin, were given weekly injections of testosterone enanthate, 200 mg IM, during the suppression (6-month) and efficacy (12-month) phases. Patterns of sperm suppression were assessed by semen analysis at monthly or 2-weekly intervals. Sperm counts suppressed more slowly in the Asian than in the non-asian men in the first 2 months of injections but subsequently suppressed to lower sperm concentrations by 6 months. The cumulative life table rates of suppression to sperm concentrations below 5 million/ml, 3 million/ml or azoospermia at 6 months were 97.1%, 95.6%, and 66.7%, respectively for non-asian men, compared to 99.4%, 98.4% and 89.2%, respectively for Asian men. In conclusion, a hormonal contraceptive method based on regular testosterone injections can suppress spermatogenesis to azoospermia or severe oligozoospermia in 97% of men, regardless of their ethnic origin.

To determine the relationships between pre-freeze semen variables and cryosurvival rate and post-thaw motility and examine whether they have any predictive value for the cryosurvival rate and post-thaw sperm motility, conventional semen analysis, supravital staining for sperm viability and hypo-osmotic swelling test were performed on 50 semen samples before cryopreservation. Thawed semen samples were examined for post-thaw sperm motility and cryosurvival rate. Significant correlations were observed between post-thaw sperm motility and several pre-freeze semen variables, such as, hypo-osmotic swelling test, pre-freeze sperm motility and sperm viability. In a stepwise regression analysis, an accurate prediction of post-thaw sperm motility (R = 0.826) was obtained using a multiple regression equation incorporating 3 variables including hypo-osmotic swelling test, pre-freeze sperm motility and sperm concentration. In conclusion, a set of criteria have been identified that accurately predicts post-thaw sperm motility and which place particular emphasis on hypo-osmotic swelling test. Conventional semen analysis and hypo-osmotic swelling test are simple and effective assays for the prediction of post-thaw motility.

In routine semen analysis of 102 patients the values of sperm concentration and the percentage of sperm motility were measured with the Hamilton-Thorn Motility Analyzer (HTMA) and compared to the data obtained by conventional semen analysis according to the guidelines of the World Health Organization (WHO). Results were classified according to the conventional semen analysis before statistical analyses. Overall, sperm concentration by both methods showed a correlation of 0.95 (p < 0.0001) but the HTMA gave higher values for sperm concentration (mean difference 10.8 +/- 18.9 x 10(6)/ml, mean +/- S.D.). Only a sperm concentration of between 40 and 80 x 10(6)/ml can be measured accurately with the HTMA. The percentage of sperm motility by both methods showed a correlation of 0.759 (p < 0.0001) but were estimated slightly lower by the HTMA than by conventional analysis (mean difference 1.7 +/- 15.8%). In conclusion, the HTMA system can not replace conventional semen analysis in routine semen analysis.

Efficacy of intrauterine insemination (IUI) using washed spermatozoa for treatment of oligozoospermia was evaluated by a prospective randomized study in 50 couples, using LH-timed natural intercourse in the alternate menstrual cycles as a control. The quality of spermatozoa in terms of their concentration and motility before and after sperm washing was compared. Sperm motility increased significantly after sperm preparation but the number of sperm was reduced. Eight pregnancies occurred in 253 cycles of IUI with washed spermatozoa and clomiphene citrate-stimulated cycles (3.16% per cycle). Only one patient conceived in 242 LH-timed natural intercourse cycles (0.41% per cycle). Compared with LH-timed natural intercourse, IUI provided a significantly improved pregnancy rate. When the sperm count was < 5 x 10(6) per ml, no pregnancy occurred with the IUI method. Therefore, IUI is a of rather limited usefulness when the sperm quality is very poor. Few complications occurred after IUI, but included slight cervical contact bleeding and mild abdominal discomfort and/or cramps. In conclusion, IUI should be considered as a useful and relatively non-invasive therapeutic modality for treating caused by moderate oligozoospermia (> 5 x 10(6)/ml), when sexual intercourse fails.

Computer-assisted sperm movement analysis was used to study the effect of pentoxifylline on human sperm motility characteristics and motility longevity of postthaw cryopreserved semen. This study focused on the following issues: the changes in individual movement characteristics in response to pentoxifylline, the persistence of the response during drug treatment. Computerized analysis was started at 30 min, 3 hrs and 24 hrs, after addition of pentoxifylline. Data obtained showed that pentoxifylline significantly increased percentage of sperm motility, average path velocity (VAP), curvilinear velocity (VCL), straight line velocity (VSL), amplitude of lateral head displacement (ALH) at two of the three time periods (p < 0.05). But, it did not significantly increase linearity (LIN), straightness (STR), and beat cross frequency (BCF) at any time. After 24 hrs, all motility variables were significantly decreased in both groups. However, the 24-hr motility longevity in the treatment group was greater than that of the control group. The present analysis shows interest in the use of pentoxifylline as a sperm movement enhancer for postthaw cryopreserved semen. It shows a beneficial effect in the majority of sperm movement parameters and motility longevity which may increase pregnancy rates after insemination. However, whether this change leads to an increase in fertilizing ability requires further study.

Evaluation of male fertility is based predominantly on results from semen analysis and determination of the sperm concentration is one of the main parameters of the analysis. To assess the accuracy of sperm concentration measurements by Makler counting chamber, manual sperm counting of 55 semen samples were made using a Makler counting chamber, and compared with concentration values measured using an improved Neubauer hemocytometer according to the World Health Organization guideline (standard procedure). Results were classified according to the standard procedure before statistical analyses. Both values correlated well. Sperm concentration obtained with Makler counting chamber was not statistically different from those determined by improved Neubauer hemocytometer in semen samples with concentrations over 40 x 10(6)/ml. But using Makler counting chambers caused a shift concentrations, which were overestimated significantly (p less than 0.0001) in semen samples with concentrations less than 40 x 10(6)/ml. Overall, Makler chamber counts were 11.2 per cent higher. Although less complicated than the improved Neubauer hemocytometer method, measurement of sperm concentration by Makler counting chamber is an inaccurate method, especially in semen samples with concentrations less than 40 x 10(6).

Objective: To assess the role of varicocele in male infertility.(~)Design: Data analysis of a large population of couples who were systematically investigated for infertility.Settings: Couples were recruited in 34 World Health Organization collaborating centers in 24 countries.Patients: Nine thousand thirty-four men presenting as partner of infertile couples.Interventions: None.Main Outcome Measures: Physical findings, semen characteristics, coincidental pathology, and spontaneous pregnancies.Results: Varicocele was found in 25.4% of men with abnormal semen, compared with 11.7% of men with normal semen. It was accompanied by decreased testicular volume, impaired sperm quality, and decline of Leydig cell secretion. Spontaneous pregnancies were as frequent in couples in whom the men did or did not have varicocele.Conclusion: Varicocele is clearly associated with impairment of testicular function and infertility.

The fertility profile of 307 Thai male volunteers whose wives were currently in early pregnancy was established by genital examination, semen analysis and serum hormone analysis. Ninety percent of the subjects had testicular volumes of 12-25 ml (mean 17.2 ml) which was found to relate to body weight, height and the ponderal index as well as to the sperm count. However, values for semen analysis were significantly below the recognised standard for Caucasian males. There was an inverse relationship between testicular volume and the serum concentration of FSH, LH and prolactin. It is suggested that a common protocol for male fertility assessment should be used to establish standard parameters for racially different male populations.

This discussion of psychosexual factors in infertility focuses on the following: sexual dysfunctions in infertility (impotence ejaculatory impotence premature ejaculation vaginismus orgasmic dysfunction); coital factors in infertility (coital frequency coital error effluvium seminis coital technique); effect of infertility on psychosexual function; clinical aspect of psychosexual problems and infertility; and management. The importance of sexual problems as a cause of male infertility has been emphasized by Dubin and Amelar (1972). The etiology of sexual dysfunction is primarily psychogenic but functional and organic pathology may also be involved. If primary sexual failure occurs in 1 partner it can produce dysfunction in the other. Sexual dysfunctions usually are psychosomatic disorders. Both the vasocongestive and the orgasmic components of the sexual response may be inhibited together or separately. Macleods study indicates that at almost any age the chance of conception being achieved in less than 6 months rises with the frequency of intercourse yet Dubin and Amelar reported 6 cases of male infertility due to too frequent ejaculations. Daily ejaculation may have no clinically significant effect on the sperm count of a man who normally has a high sperm concentration. Effluvium seminis is a common phenomenon and is not a cause of infertility but a woman cleaning or douching herself immediately after intercourse is not encouraged for subfertile women. The best coital position for achieving conception is that of the male above with the female lying supine underneath. Infertile couples undergo much stress when they are unable to conceive. Many couples may find that their sexual pleasure and functioning become impaired. Infertile couples may have abnormalities in sexual functioning which can present in several ways: as psychosexual problems causing infertility; as infertility resulting in psychosexual dysfunction; or as incidental findings of psychosexual disturbances in cases of infertility. In the management of infertility associated with psychosexual problems the doctor must have an empathic understanding and nonjudgemental attitude and should be ready to encourage the couple to speak openly about their anxiety in a relaxed confidential and private setting. The couples attitudes concerning sexual behavior must be identified and help must be provided to modify them when appropriate.

A prospective study of the emotional reaction to interval sterilization was conducted by means of interviews 1 week prior to sterilization and 7 months postoperative with 155 Buddhist Thai women aged 35 years or under, living in Bangkok, and undergoing interval laparoscopic sterilizations for socioeconomic indications. The mean age of subjects was 27.8 years, with a range of 19-35, mean duration of marriage was 8.0 years, and mean number of children was 2.8. 56.1% of the women were housewives, 77.0% had a low educational level, and 100% were of lower socioeconomic status. 65 subjects reported psychophysiologic and emotional symptoms prior to operation, 51 continued to complain of the symptoms 6 months later, and 10 women developed new symptoms postoperatively. In the preoperative interviews, 26 women complained of irritability, 25 of headache and backache, 10 of weakness and lethargy, 11 of giddiness or fainting, 5 each of palpitation and breathing difficulty, 8 of insomnia, 4 each of anorexia and gastrointestinal upset, and 3 of other conditions. Of the 10 women developing symptoms postoperatively, 6 complained of irritability, 5 of headache, 3 of insomnia, and 1 each of weakness and lethargy, giddiness or fainting, and anorexia. Irritability and headache, which accounted for most of the symptoms, were mostly mild and few required medication. Further psychiatric investigation into personal backgrounds of subjects with psychophysiologic or emotional symptoms revealed that practically all had concurrent problems with their marriages, children, finances, or relatives, with marital problems the most frequent. 35% of subjects reported postoperative menstrual disturbances, but 72% of the sample had been on oral contraceptives or IUDs, which can influence menstrual patterns. 8 and 10 women respectively reported increased sexual drive and sexual satisfaction, 6 and 3 reported decreased drive and satisfaction, and 141 and 142 reported no change in desire or satisfaction. 5 reported postoperative dyspareunia. 145 husbands and 152 wives stated they were satisfied with the operation.

Five thousand cases of laparoscopic tubal electrocoagulation were performed for voluntary interval sterilization in outpatient Thai women from January 1974 through June 1978. Immediate complications occurring during surgery resulted from mesosalpingeal hemorrhage, which was successfully managed by omental packing with or without repeated electrocoagulation. The overall failure rate was 0.40%. The authors find this method of tubal electrocoagulation for fertility management to be reliable and safe as an outpatient procedure and to provide rapid convalescence.

A study was carried out to compare the emotional reaction of Thai women to interval and postpartum sterilization. Two groups of 150 women each were matched for similar characteristic features. They were assessed using group discussion techniques under the supervision of a woman psychiatrist. Results of this study showed that the incidences of psychophysiologic and emotional symptoms, as evaluated 12 months postoperatively, were 41.3% in the interval group and 42.0% in the postpartum group. Psychologic sequelae of sterilization were not related to the time of sterilization. A majority of the reported symptoms were mild and related most frequently to poor personal background, previous psychiatric disorders and marital or economic problems.