The objective of the study was to obtain information on the concentration and distribution of selenium throughout the human male reproductive tract. Material was removed at autopsy from 41 men who had died suddenly and unexpectedly. Semen samples were also provided from 184 men attending an andrology clinic for fertility investigation and from 32 healthy volunteers. Significant positive correlations in the selenium concentration were demonstrated between the different reproductive organs, the testis having the highest concentrations. No correlation was found between the concentration of selenium in the genital organs and liver, kidney or blood, suggesting that its uptake and/or biochemical activity in the reproductive organs may be controlled by similar mechanisms not shared by the other organs. No significant age-dependent changes could be detected in tissue selenium concentrations. In a group of men under fertility investigation, a significant positive correlation was obtained between seminal plasma concentrations of selenium and concentrations of spermatozoa in the same ejaculate. A significant positive correlation between concentrations of zinc and selenium in the same ejaculates indicated that selenium may arise largely from the prostate gland.

A retrospective study was carried out which focused on the impact of lifestyle and exposure to different external factors on sperm quality. A questionnaire was sent to 312 men who had previously attended our laboratory for semen analysis. Their answers were correlated to sperm quality. Men exposed to a relatively high degree of X-rays were found to have significantly reduced sperm count. A previous symptomatic genital infection did not significantly influence the sperm quality, but an earlier sexually transmitted disease in the female partner was associated with a reduced rate of pregnancy. Frequency of ejaculation was significantly positively correlated to sperm motility and inversely related to both semen volume and proportion of sperm with abnormal morphology. Information on exposure to the remaining factors was not related to reduced sperm quality or fertility.

The total quantity of zinc in the ejaculates of smokers was significantly lower than in non-smokers. This was not related to a significant increase in the quantities of seminal cadmium or lead, or to a decrease in sperm quality in the smoking group. It appears that tobacco consumption may have to exceed 20 cigarettes/day before a noticeable increase in seminal cadmium can be recorded. It is suggested that this reduction in zinc secretion may jeopardize the content of chromatin zinc, and thereby the stability of the sperm chromatin. This may then contribute to reproductive failure or have consequences for fetal development.

Regional differences in the total activities of the epididymal secretory parameter, alpha-glucosidase, were demonstrated in the 20,000 g supernatants of human epididymal homogenates. A comparison of the enzymic activities in the supernatants and the washings from 12 one centimetre segments of human epididymides indicated an activity peak in segments 3-4 which appeared to be largely intracellular and which presumably reflects the acidic isoenzyme. A second peak in the caudal region, the segmental localization of which was more variable and differed in post-mortem and operation specimens, appeared to be primarily intraluminal. The activities of ornithine decarboxylase (ODC), the rate-limiting enzyme in the polyamine pathway, also exhibited regional differences with higher activities in relatively short segments in both caput and caudal portions. Corresponding alterations were also found in the tissue concentrations of the enzyme products, spermidine and spermine. The increased intracellular activities of ODC and alpha-glucosidase in the distal caput segments presumably reflect the transition of epithelium from the efferent to the epididymal ducts.

The use of sterile particle filters is described for the washing and incubation of living sperm before the indirect IBT. The filters greatly simplify the technique, shorten its duration, and remove all centrifugation steps that have potentially detrimental effects on the sperm. The same filters have a variety of applications and can be used whenever sperm have to be washed or incubated before biochemical tests including acrosome binding studies and flow cytometry.

The concentrations of lead in blood and the concentrations of lead, cadmium and zinc in tissues were determined in various reproductive organs, liver and kidney removed at necropsy from 41 men who had died suddenly. None of the reproductive organs specifically accumulated lead and no significant correlation could be demonstrated between blood and organ concentrations or between concentrations and age, occupation or urban/rural background of the subject. Unlike lead, the tissue concentrations of cadmium increased with increasing age in all of the reproductive organs examined. Of these, the epididymides and seminal vesicles contained the highest concentrations. Whereas prostatic zinc also exhibited a significant age-dependent increase, the concentrations in the testes declined with age. The age-dependent increase in testicular cadmium did not become apparent until after the fourth decade, when any potentially deleterious impact on male fertility has less relevance. It is concluded that measurable amounts of lead and cadmium are present in all of the human reproductive organs but their organ and age distributions do not offer strong support for their involvement in the aetiology of male infertility or in the genesis of glandular neoplasms.

Semen was obtained by vibration-induced ejaculation from 5 spinal injured men once a week for 5 consecutive weeks under standardised conditions. The site of the spinal lesions varied from C5 to Th10. Although in all subjects except one, the total sperm count in the first ejaculate was within normal limits, conventional criteria indicated a high degree of asthenoteratozoospermia in all cases. In subsequent ejaculates there was no major general improvement in motility, vitality or morphology. However, 2 individuals exhibited a marked increase in the proportion of motile sperm in the ejaculate over the next 3 weeks. Flow cytometry of the same sperm samples indicated a high degree of abnormal chromatin condensation and reduced binding of a fluorescent acrosomal marker in the first ejaculates. No improvement in these parameters could be detected with time.Assessment of accessory sex gland function using specific secretory markers indicated that compared to the normal population, the vesicular contribution was markedly reduced in 3 subjects and prostatic contribution in the 2 remaining subjects in the first and subsequent ejaculations. Ejaculate volumes were consistently low in all subjects during the observation period. In contrast, total epididymal secretion was comparable to normal ejaculates. Prostatic contributions to the ejaculate increased significantly over the first 4 weeks.In conclusion, regular vibration-induced ejaculation at weekly intervals could not improve sperm quality in paraplegic men to an acceptable degree for assisted fertilisation to be recommended. Although certain aspects of sperm quality, as judged by conventional criteria, were improved in some cases, flow cytometry revealed persistent chromatin and acrosomal abnormalities.

The following are the conclusions that can be derived from a review of the literature regarding the role of infection in the aetiology of male infertility. (i) Temporary inflammatory episodes in the male reproductive tract which are self-limiting are probably common. (ii) Caution should be exercised in the use of leukospermia or bacteriospermia as parameters for glandular infection. (iii) Ther is a need for alternative techniques for detecting non-symptomatic deep pelvic infections in the male; one technique of great promise is rectal ultrasound. (iv) Rectal ultrasound indicates that a large number of men with poor sperm quality have a non-symptomatic, chronic prostatovesiculitis. (v) Increasing evidence implicates Chlamydia trachomatis as being a major cause of chronic non-bacterial prostatitis. (vi) An important aspect of chlamydial infections in men may be that the male accessory sex glands may function as reservoirs for the organism, increasing the probability of infection in the female. (vii) Ureaplasma urealyticum may also play an important aetiological role in male infertility but its significance is confounded by its acknowledged function as a commensal in the reproductive tract. (viii) One of the manifestations of male reproductive tract infection is the induction of sperm autoantibodies. (ix) There is a need for more systematic controlled studies of the effects of antibiotic treatment on sperm quality with different preparations for extended periods using patient groups in which a glandular infection has been verified, e. g. by rectal ultrasonography.

OBJECTIVE:To determine the extent to which sperm chromatin varies in its degree of condensation in 53 apparently normozoospermic men and in 14 men of proven fertility.METHODS:DNA flow cytometry after staining of spermatozoa with ethidium bromide and mithramycin.RESULTS:Normozoospermic men could be divided into four subgroups according to the fluorescence pattern of their sperm DNA. More than half of the normozoospermic group and all of those of proven fertility shared a similar profile with a narrow symmetrical peak of haploid fluorescence without significant sub-populations. Deviations from this pattern were generally not associated with any major differences in sperm quality.CONCLUSIONS:(a) Current criteria for normozoospermia should be expanded to include additional tests of biochemical integrity. (b) Fertilizing ability appears to be associated with a relatively homogeneous profile of sperm DNA condensation.

OBJECTIVE To find differences in effect on sperm motility of agents that increase intracellular cAMP: manganese ion, methyl-isobutyl-xanthine (MIX), 2-deoxyadenosine, glucose, and Mn-MIX and Mn-glucose. DESIGN Nine men with asthenozoospermia vs. fertile donors. METHODS Sperm was washed in Hepes-buffered saline, motility tested by laser-Doppler technique. RESULTS Best activation was obtained with Mn and 2-deoxyadenosine; generally poor response to MIX or glucose. CONCLUSIONS Usually, poor endogenous stimulation of adenylyl cyclase, and probably not limited energy supply, is the cause of impaired motility.

Objective-To assess the effect of asymptomatic pelvic organ infection, as revealed by ultrasound, on sperm quality. Patients and Methods-Clinical and andrological examination and rectal ultrasonography were performed on 100 consecutive asymptomatic men attending our fertility laboratory, without the physician having any prior knowledge of their sperm quality. Results-In general, the presence of the following could be statistically related to sperm pathology: (a) a tender prostate gland upon palpation, (b) ultrasonographic evidence of chronic vesiculitis, (c) unilateral or bilateral testicular atrophy, and (d) the presence of a varicocele. Seminal leukocytosis, a tender epididymis, and the presence of prostatic calculi had less or no predictive value for poor sperm quality. Conclusion-In a large number of cases, sperm pathology may reflect asymptomatic infections in the reproductive tract, and rectal ultrasonography is a valuable aid in demonstrating inflammation in the deep pelvic organs.

The effects of simvastatin 40 mg per day for 14 weeks on the pituitary-testis axis of 19 men with familial hypercholesterolaemia have been examined in a single-blind study. Simvastatin significantly reduced serum low density lipoprotein (LDL) cholesterol and triglycerides by 45% and 30%, respectively, and significantly increased high density lipoprotein (HDL) cholesterol by 15%. The alterations, which were stable 4 weeks after the start of treatment, were not associated with any significant change in sperm quality, the seminal plasma concentrations of various sex gland products (prostate-specific acid phosphatase, polyamines, citrate, fructose, alpha-glucosidase), or the serum concentrations of cortisol, testosterone, LH, FSH, or prolactin. It is concluded that a short-term reduction in circulating LDL-cholesterol has no marked effect on testicular function or sperm quality.

This study is based on a questionnaire which focused on the possible association between life-style factors and male fertility in a group of 252 men attending our laboratory in connection with a fertility investigation. Their answers were correlated to sperm quality. No association could be documented between sperm quality and smoking habits, coffee drinking, a moderate alcohol intake, exposure to heat (sauna, hot baths, type of underwear, sedentary activities), or physical activities in their leisure time. In contrast, the reported average ejaculation frequency was significantly positively correlated to the motility of the sperm (% progressive), and inversely related to the proportion of sperm with abnormal morphology and semen volume. This indicates that the life style of the subject has little if any impact on semen quality, at least within the limits recorded in the present study.

Almost one-quarter of 100 asymptomatic men under fertility investigation had significant titres of IgA antibodies (> 1:8) specific for Chlamydia trachomatis in seminal plasma. No clear association was evident between the presence of these antibodies and sperm quality. In a second study, the female partners of men with consistently high serum or seminal plasma levels of chlamydia-specific IgA also exhibited a positive IgA reaction in serum without any clinical indications of the presence of an infection. In one group of men and women, antibiotic treatment for 4 weeks resulted in the disappearance of the IgA from the serum after a variable period of less-than-or-equal-to 12 weeks. The study indicates that chronic asymptomatic infections with Chlamydia trachomatis may be responsible for a large number of cases of infertility. It also implies that all men and women under investigation for infertility should be routinely screened with chlamydial serology regardless of previous history and clinical findings.

DNA flow cytometry of sperm from 100 randomly chosen men undergoing fertility investigation revealed a general association between reduced sperm quality, as judged by conventional parameters, and the appearance of sperm with lower degrees of chromatin condensation in the ejaculate as measured by DNA fluorescence intensity. Chromatin hypocondensation, as measured by increased fluorescence, was manifested to different degrees in different samples. In many cases of more extreme sperm pathology, such as oligoasthenoteratozoospermia (OAT), the whole population of spermatozoa appeared to be affected. Significant numbers of hypercondensed spermatozoa were present in both normozoospermic men and men with different degrees of disturbance in sperm quality. All of the different parameters of sperm quality could be correlated significantly with certain of the flow parameters, although not one in particular could be used to predict deviations from the normal flow profile. In several asthenoteratozoospermic men and a small proportion of men with OAT, the DNA profiles were normal, implying that in these cases the disturbance may not be so fundamental. The presence of leucocytes in the ejaculate was associated with a general increase in the preponderance of hypocondensed subpopulations of spermatozoa in men with OAT as well as in normozoospermic subjects, emphasizing the effect of inflammatory conditions in the reproductive tract on sperm quality.

In order to establish a series of provocation tests to evaluate the integrity of the sperm cAMP pathway, manganese (Mn), 2-deoxyadenosine (DEA) (via adenylyl cyclase), and methyl-isobutyl-xanthine (MIX) (via phosphodiesterase) were tested for their capacity to activate the progressive motility of human sperm. Optimal responses were obtained using washed sperm previously incubated for 3 hours in substrate-poor medium (Hepes-buffered saline). Longer periods of incubation required the presence in addition of an energy substrate such as glucose. Exposure of sperm to seminal plasma for 24 hours prior to washing attenuated the responsiveness of the sperm to the different activators. Preliminary studies on the activation of the progressive motility of washed sperm from four normozoospermic men under fertility investigation, prepared under identical conditions, revealed differences in the pattern of response which may have pathophysiological relevance.

The study was designed to assess the value of information from male subjects under fertility investigation, regarding previous genital infection, in clarifying the causes of depressed sperm quality. Information was gathered using a questionnaire which was sent to 312 men who had previously attended our laboratory for semen analysis. A previous sexual transmitted disease (STD) in the male partner did not significantly influence the sperm quality or the pregnancy rate. However, a previous STD in the female was generally associated with a lower pregnancy rate. Previous episodes with urethral discharge, dysuria, pain with ejaculation or suprapubic discomfort had little relevance for the subsequent sperm quality. The results indicate that, in general, information provided by men under fertility investigation, regarding previous genital infections or symptoms, is only of limited value in elucidating the cause of impaired sperm quality.

This study summarizes the results of a questionnaire sent to 312 men involved in a fertility investigation. The answers illustrate the psychological problems linked to the infertile state, and indicate that men are generally well orientated about the extent of the problem. In the majority of cases, the infertile couples first contacted a gynecologist rather than a general practioner or other specialist. In over one third of the cases, this contact occurred within the first 12 months of attempting to achieve a pregnancy. The study implies an increasing negative attitude to donor insemination, and approximately one fifth of the men had at some time consulted fringe medicine.

Fourteen men each provided semen samples after 3, 6, and 10 days abstinence in a sequence decided by the individual and over a period of approximately 6 weeks. The proportion of sperm displaying progressive motility remained relatively constant up to 6 days but declined after a further 4 days of abstinence. This decrease was not associated with any major changes in sperm morphology or vitality. The total number of sperm with progressive movement in the ejaculate increased after 6 days and remained high after 10 days of abstinence. In subjects with asthenozoospermia, the greatest increase in the total number of sperm in the ejaculate occurred between 6 and 10 days. For men with reduced sperm quality participating in assisted fertilization programs, it may be advantageous to advise longer periods of abstinence, up to 10 days, prior to semen collection.

Semen analyses were performed on 50 men with chronic abacterial prostatovesiculitis (CPV) and 25 asymptomatic control subjects. All subjects had had symptoms of at least three months' duration, and the diagnosis was verified by rectal ultrasonography and after microbiologic culture of seminal plasma. Fifty-eight percent had increased concentrations of leukocytes (>1 × 106/mL) in the ejaculate compared with 15 percent in the controls. Only 10 percent of the CPV subjects could be classified as normospermic compared with 60 percent in the controls. The incidence of severe disturbances in sperm quality and azoospermia was also four times greater in the CPV group. Neither the degree of leukospermia nor the ultrasonographic findings could predict the extent of the disturbance in sperm quality.