Treatment of Male Infertility

340 Pages·1982·17.83 MB·English

by  Jerald Bain (auth.)

Treatment of
Male Infertility
Edited by
Jerald Bain, Wolf-Bernhard Schill
and Luis Schwarzstein
With 98 Figures
Springer-Verlag
Berlin Heidelberg New York 1982
Jerald Bain, M.D.
Division of Endocrinology and Metabolism
University of Toronto and Mount Sinai Hospital
600 University Avenue; Suites 639-640
Toronto, Ontario M5G IX5; Canada
Prof. Dr. Wolf-B. Schill
Dermatologische Klinik und Poliklinik
der UniversiHit Munchen
Frauenlobstr. 9-11
8000 Munchen 2, West Germany
Dr. Luis Schwarzstein
Grupo de Estudio en F ertilidad y Endocrinologia de Rosario
Cordoba 1764
2000 Rosario (SF), Argentina
ISBN-13: 978-3-642-68225-4 e-ISBN-13: 978-3-642-68223-0
DOl: 10.1007/978-3-642-68223-0
Library of Congress Cataloging in Publication Data.
Main entry under title: Treatment of male infertility. Includes bibliographies
and index. 1. Infertility, Male-Treatment. I. Bain, Jerald. II. Schill, W.-B.
(Wolf-Bernhard), 1939-. III Schwarzstein, Luis, 1938-. [DNLM: 1. Sterility,
Male-Therapy. WJ 709 T784]
RC889.T73 616.6'92 82-3349
ISBN-13 :978-3-642-68225-4 (U.S.) AACR2
This work is subject to copyright. All rights are reserved, whether the whole
or part of the material is concerned, specifically those of translation, reprint
ing, re-use of illustrations, broadcasting, reproduction by photocopying ma
chine or similar means, and storage in data banks.
Under § 54 of the German Copyright Law where copies are made for other
than private use a fee is payable to 'Verwertungsgesellschafi Wort', Munich.
© Springer-Verlag Berlin Heidelberg 1982
Softcover reprint of the hardcover 1st edition 1982
The use ofregistered names, trademarks, etc. in this publication does not im
ply, even in the absence of a specific statement, that such names are exempt
from the relevant protective laws and regulations and therefore free for gen
eral use.
2121/3321 543210
Contents
List of Contributors . xv
Preface . XIX
I. General Considerations
Male Infertility: Problems in Assessing Response to Treatment
(1. Bain) ...................... .
II. Medical Treatment
1 Inflammation and Infection (c. R. D. Nahoum) 5
1.1 Inflammation of Male Accessory Sex Organs 5
1.1.1 Genital and Rectal Examination 5
1.1.2 Collection and Processing of the Prostatic
Vesicular Fluid (PVF) 6
1.1.3 Cytological Examination ofPVF 7
1.1.3.1 Cellular Elements of the PVF 7
1.1.3.2 Quantitative Changes of the PVF Cells During
Inflammation 8
1.1.3.3 Qualitative Changes of Epithelial Cells During
Inflammation 11
1.1.3.4 Cellular Patterns of the Smears 11
1.1.4 Molecular Tracers of the Inflammatory Process 11
1.1.4.1 Immunoglobulins 12
1.1.4.2 C Factor of the Complement System 12
3
1.1.4.3 Albumin 14
1.1.4.4 aI-Antitrypsin 14
1.1.4.5 aI-Acid Glycoprotein 15
1.2 Infectious Male Adnexitis 15
1.2.1 General Considerations 15
1.2.2 Qualitative and Quantitative Data on Genital
Infection in Infertile Patients 17
1.3 Secretory Function of Accesory Glands and Male
Adnexitis 18
1.4 Treatment of Male Adnexitis 19
1.4.1 Introduction 19
1.4.2 Therapeutic Procedures 19
VI Contents
1.4.3 Follow-Up 26
1.5 Gaps in Our Knowledge 26
1.6 References 27
2 Clomiphene Citrate in the Treatment of Male
Infertility (A. M. C. M. Schellen) 33
2.1 Testicular Control and Function 34
2.2 The Clomiphene Test 35
2.3 Clomiphene Citrate in Male Infertility 37
2.3.1 Clomiphene Citrate Therapy 37
2.3.2 Material and Methods 37
2.3.3 Review of Results Obtained with Clomid 40
2.4 Side and Secondary Effect of Clomiphene Citrate 41
2.5 Discussion 41
2.6 References 42
3 Tamoxifen (F. H. Comhaire) 45
3.1 Mode of Action 45
3.2 Patients 46
3.3 Results 47
3.3.1 Plasma Hormone Levels 47
3.3.1.1 Testosterone 47
3.3.1.2 Estradiol 47
3.3.1.3 Gonadotropins (LH and FSH) 48
3.3.2 Sperm Characteristics 49
3.3.2.1 Sperm Concentration 49
3.3.2.2 Sperm Motility 50
3.3.2.3 Sperm Morphology 50
3.3.3 Biochemical Composition of Seminal Plasma 50
3.3.4 Pregnancy 51
3.3.5 Side Effects 51
3.4 Conclusions 52
3.5 References 52
4 LHRH and Its Analogs in the Treatment of
Idiopathic Normogonadotropic Oligozoospermia
(L. Schwarzstein and N. Aparicio) 55
4.1 General Considerations 55
4.1.1 Hypothalamic Hormones 55
4.1.2 Male Infertility 56
4.2 Experience with LHRH and Its Analogs 57
4.2.1 Selection of Patients 57
4.2.2 Evaluation of Results 57
4.2.3 Experience with LHRH 58
4.2.4 D-Leucine6-LHRH-Ethylamide 61
4.2.5 D-Tryptophan6-LHRH 64
4.3 Conclusions 66
4.4 References 67
Contents VII
5 Hyperprolactinemia in Male Infertility: Treatment
with Bromocriptine (E. del Pozo) 71
5.1 Control of PRL Release: The Role of Dopamine
and Estrogens 71
5.2 Modification of PRL Secretion by Pharmacolog-
ical Agents and Drug Interaction 73
5.3 Physiology and Physiopathology of PRL in Men 76
5.4 Incidence and Causes of Male Hyperprolactinemia 77
5.5 Biological and Biochemical Effect of Excessive
PRL Secretion in Men 78
5.6 Bromocriptine Treatment of Male Hypogonadism 79
5.7 Conclusions 81
5.8 References 82
6 Gonadotropin Therapy in Male Infertility
(S. J. Winters and P. Troen) 85
6.1 Gonadotropin Preparations 87
6.1.1 Pituitary Gonadotropins 87
6.1.2 hCG 87
6.1.3 FSH 87
6.2 Hypogonadotropic Hypogonadism 88
6.2.1 Treatment of Hypogonadotropics with hCG 89
6.2.2 Therapy with hMG 91
6.2.3 Therapy with hCG and hMG 91
6.3 Gonadotropin Treatment in Idiopathic Oligozoo-
spermIa 94
6.4 Conclusions 97
6.5 References 98
7 Androgen Therapy in Hypogonadism and Infertility
(E. Nieschlag and C. W. Freischem) 103
7.1 Mechanism of Testosterone Action 103
7.2 Pharmacology of Androgens 104
7.2.1 Free Testosterone 104
7.2.2 Parenteral Testosterone Esters 106
7.2.3 Testosterone U ndecanoa te 108
7.2.4 Synthetic Androgens 108
7.2.4.1 Methyltestosterone 108
7.2.4.2 Fluoxymesterone 109
7.2.4.3 Mesterolone 109
7.2.5 Testis Sicca and Testis Extracts 109
7.3 Clinical Application 109
7.3.1 Substitution of Endocrine Testicular Insufficiency 109
7.3.2 Idiopathic Delayed Puberty 110
7.3.3 Excessively Tall Boys 110
7.3.4 Androgens in Advanced Age 112
VIII Contents
7.3.5 Testosterone Rebound Therapy as Treatment of
Male Infertility 112
7.4 References . 113
8 Mesterolone: a New Androgen for the Treatment
of Male Infertility (B. N. Barwin) 117
8.l Properties of Mesterolone 117
8.2 Literature Review 118
8.3 Toleration and Function of the Liver 120
8.4 Conclusions 122
8.5 References 123
9 Kinin-Releasing Pancreatic Proteinase Kallikrein
(W. B. Schill) 125
9.l Kallikrein-Kinin System 125
9.1.1 Biochemistry and Physiology 125
9.1.2 Reproductive Functions 127
9.2 Experimental Investigations 128
9.2.1 In Vitro Studies 128
9.2.2 Animal Studies 130
9.2.3 Biochemical and Endocrinological Studies in Men 130
9.3 Clinical Investigations and Application 131
9.3.l Systemic Kallikrein Treatment 131
9.3.1.1 Open Clinical Trials 132
9.3.1.2 Double Blind Studies 132
9.3.l.3 Routes of Administration and Side Effects 134
9.3.2 In Vitro Improvement of Human Semen 135
9.4 Conclusions 137
9.5 References 138
10 Treatment of Male Infertility with Nucleotides
(G. F. Menchini-Fabris and M. Mariani) 143
1O.l Structure and Metabolism 143
10.2 Clinical Studies 145
10.2.1 Procedure 146
10.2.2 Treatment 148
10.3 Results 148
10.4 Conclusion 152
10.5 References 152
11 Immunological Infertility in Men: Clinical and
Therapeutic Considerations (J. Friberg) 153
11.1 The Different Types of Sperm Antibodies
Observed in Men 154
11.2 Antibody Nature of Sperm-Agglutinating and
Sperm-Immobilizing Activities 155
1l.3 Causes of Sperm Antibody Production 156
Contents IX
11.4 The Significance of Sperm Antibodies in Men 157
11.5 Treatment of Men with Sperm Antibodies 159
11.5.1 Treatment of Men with Genital Infections .. 159
11.5.2 Surgical Treatment ........... 160
11.5.3 Sperm Washing and Intrauterine Inseminations 160
11.5.4 Immunosuppressive Treatment 161
11.5.4.1 Low-Dose Corticosteroids 161
11.5.4.2 High-Dose Corticosteroids 162
11.5.4.3 Azathioprine . . . . . . 164
11.5.5 The Testosterone Rebound Phenomenon and
Sperm Antibodies 164
11.6 Conclusions 165
11.7 References . . . 166
12 Nonsurgical Treatment of Varicocele
(M. P. P. de Castro) 169
12.1 Historical Background . 169
12.1.1 Diagnosis of Varicocele 170
12.1.2 Treatment of Varicocele 170
12.2 Transcatheter Sclerosis of the Spermatic Veins 171
12.3 Technique . . . . . . . 172
12.4 Observations in 88 Patients 172
12.5 Conclusions 176
12.6 References . . . . . . . 177
13 Retrograde Ejaculation (J. P. Collins) 179
13.1 Anatomy of the Male Urethra and Internal
Genitalia .......... 179
13.2 Physiology of Ejaculation . . . . . 180
13.3 Etiology of Retrograde Ejaculation . 181
13.4 Diagnosis of Retrograde Ejaculation 183
13.5 Treatment of Retrograde Ejaculation 184
13.5.1 Retrieval of Semen ....... 184
13.5.1.1 Replacement of Bladder Urine with an Isotonic
Alkaline Solution . . . . . . . . . . . .. 184
13.5.1.2 Systemic Alkalinization of the Urine . . . .. 185
13.5.1.3 Washing of Semen in Nutrient Alkaline Solution 185
13.5.2 Medication 186
13.5.3 Surgery 187
13.5.4 Miscellaneous 187
13.6 Conclusions 187
13.7 References . 188
14 Sexual Dysfunction in the Male (G. Kockott) 191
14.1 Definition ........ 191
14.1.1 Kinds of Sexual Dysfunction 191
14.1.1.1 Sexual Approach ..... 191
x Contents
14.1.1.2 Sexual Stimulation 191
14.1.1.3 Intromission and Pre orgasmic Coitus 192
14.1.1.4 Orgasm ........ . 192
14. 1. l.5 Postorgasmic Period . . . . . . . 193
14.l.2 Circumstances of Occurrence 193
14.2 Interviewing Technique and Differential Diagnosis
Between "Organic" and "Psychogenic" Male
Sexual Dysfunction 193
14.2.l Interviewing Technique 193
14.2.2 Differential Diagnosis 194
14.3 Etiology ..... . 195
14.3.l Organic Sexual Dysfunctions 195
14.3.1.1 Libido Disturbances . . 195
14.3.1.2 Erectile Impotence 197
14.3.1.3 Ejaculatory Disturbances . . 198
14.3.2 Psychogenic Sexual Dysfunctions 198
14.4 Therapy .......... . 199
14.4.l Therapy of Organic Sexual Dysfunctions 199
14.4.2 Therapy of Psychogenic Sexual Dysfunctions 199
14.4.2.1 Sexual Counseling 199
14.4.2.2 Partner Therapy .200
14.4.2.3 Psychoanalysis · 201
14.4.2.4 Behavior Therapy · 201
14.4.2.4.1 Therapy Concept and Format · 201
14.4.2.4.2 Initial Results . . .204
14.4.2.4.3 Follow-up Studies . . . . . .204
14.4.2.4.4 Conclusions ...... . · 205
14.5 Effect of Psychological Factors on the Production
and Action of Spermatozoa .205
14.6 References . . . . . . . . . . . . . . . . .207
III. Surgical Treatment
15 Varicocele: Its Role in Male Infertility
(H. Fenster and M. McLoughlin) .209
15.l Definition and Classification · 209
15.2 Pathogenesis and Etiology · 210
15.2.1 Metabolites .210
15.2.2 Heat ..... .211
15.2.3 Hormonal Factors · 212
15.2.4 Abnormal Gases · 212
15.2.5 Epididymal Factors · 212
15.3 Diagnosis · 213
15.4 Indications for Treatment · 214
15.5 Management · 215
15.5.l Surgical ...... . · 215
Contents XI
15.5.2 Medical · 217
15.6 Results · 217
15.7 Discussion and Conclusions · 218
15.8 References . . . . . . . · 219
16 Obstruction in the Male Reproductive Tract
(L. V. Wagenknecht) · 221
l6.l Causes of Obstruction of the Male Reproductive
Tract .222
16.1.1 Obstruction After Inflammation .222
16.1.2 Obstruction After Vasography .224
16.1.3 Aplasia or Hypoplasia of the Vas Deferens .226
16.1.4 Obstruction After Vasectomy · 227
16.1.5 Obstruction After Herniotomy .228
16.2 Therapy and Results · 228
l6.2.l Epididymovasostomy .228
16.2.2 Vasovasostomy · 234
16.2.3 Alloplastic Spermatocele · 237
16.3 Discussion and Conclusions .243
16.4 References .246
17 Hydrocele, Spermatocele, and Peyronie's Disease
(A. Kelami) .249
17.l Hydrocele .249
17.1.1 Definition and Etiology .249
17.1.2 Symptoms .249
17.1.3 Diagnosis .250
17.1.4 Hydrocele and Testicular Tumors .250
17.1.5 Treatment · 251
17.2 Spermatocele · 251
17.2.l Definition and Etiology · 251
17.2.2 Symptoms · 252
17.2.3 Diagnosis · 253
17.2.4 Spermatocele and Epididymal Tumors · 253
17.2.5 Treatment .254
17.3 Peyronie's Disease (lnduratio Penis Plastica) .254
l7.3.l Definition and Etiology .254
17.3.2 Symptoms · 255
17.3.3 Diagnosis · 255
17.3.4 Nonsurgical Treatment · 255
17.3.5 Surgical Treatment · 255
l7.3.5.l Excision of the Plaques · 255
17.3.5.2 Implantation of Penile Prosthesis .257
17.4 Conclusion · 260
17.5 References .260