Azospermi: Klinik ve Hormonal Bir Hastalık
Sumera AKHTAR, Samina JALALI
Department of Biological Sciences, Quaid-i Azam University, Islamabad, PAKHISTAN
ÖZET
Amaç: Bu çalışmada azospermili infentil erkeklerin kilinik ve hormonal bulguları değerlendirilmiştir.
Yöntem: Azospermili 39 hasta çalışma grubu, 52 normal erkek ise kontrol grubu olarak incelenmiştir.
Bulgular: Hasta grubu için semendevolüm, pH, like faksiyon zamanı ve beyaz küre sayılarının ortalama değerleri sırası ile 2.25 ± 0.31 mL, 7.39 ± 0.15, 27.35 ± 1.56 dakika ve 1.89 ± 0.64 bulundu. Kontrol grubu ile karşılaştırıldığında tüm değerler için istatistiksel olarak anlamlı fark yoktu.
Yorum: Azospermide anlamlı laboratuvar bulgularının serum luteinize edici hormon (LH), follikül sitümüle edici hormon (FSH), prolaktin (PRL) ve testesteron (T) düzeyleri olduğu saptandı.
Anahtar Kelimeler: Azospermi, semen, gonodotropinler, testesteron, prolaktin.
SUMMARY
Azoospermia: A Clinical and Hormonal Disorder
Objective: This retrospective study aimed to evaluate clinical and hormonal characteristics of infertile men with azoospermia.
Method: A total of 39 azoospermics men were studied. 52 males were used as normal controls.
Results:
The
mean ± SEM of semen volume, pH, liquefaction time and WBC count were 2.25 ±
0.31 mL,
7.39 ± 0.15, 27.35 ± 1.56 min and 1.89 ± 0.64/HPF, respectively. All the
variables showed non-significant differences when compared with the controls.
Conclusion: Serum levels of luteinizing hormone (LH); follicle-stimulating hormone (FSH); prolaction (PRL) and testosterone (T) were the most useful parameters in azoospermics.
Key Words: Azoospermia, semen, gonadotrophins, testesterone, prolaction.
INTRODUCTION
Azoospermia means absence of sperms in the semen (1). It is a laboratory finding concerning 17.30% of infertile men (2). It may be the result of different causes that have different prognosis and require different treatments. The hormone profile evaluation of infertile men and in particular of the genital axis-hypothalamus-adenohypophysis-testis serves as an important diagnostic tool, but it could also be used as a prognostic criterion in therapeutic consideration concerning these men (3). In a recent article, we presented clinical and hormonal results concerning 39 azoospermics.
PATIENTS and METHOD
The study included 39 azoospermics evaluated at Salma and Kafeel Infertility Clinic, Islamabad. Men duration of infertility was 7.03 years (range: 1.5 to 17 years). Control group comprised of 52 married males with normal fertility.
Clinical evaluation of infertile men included:
a. General physical and genital examination by urologist,
b. Laboratory evaluation included semen analysis and fertility hormone profile.
Semen Analysis
The male factor was evaluated by semen analysis. Samples were provided by subjects at laboratory by masturbation after abstinence for three to seven days. All the semen samples were examined immediately after liquefaction, based on WHO (1992) methods and standarts. The following variables were assessed:
Semen volume: Semen volume was noted using plastic Pasteur pippete (Pyrex, Japan).
pH: pH was noted by using pH paper (West, Germany).
Semen liquefaction: Semen liquefaction was noted after a minimum post ejaculatory interval of 20 minutes.
Sperm density: 10 µL of semen was placed in Makler counting chamber and observed at a magnification of 100 x for estimation of sperm density.
WBCs: WBCs were counted at a magnification of 400 x using microscope (Unilux, Japan).
Hormone Assay
Five mL of venous blood samples were collected in the morning after and overnight fast. Blood was allowed to clot in glass tubes, then centrifuged at 200 rpm for 10 mins. Sera were separated and Stored at -20°C until assayed for fertility hormones (LH, FSH, PRL and T) by means of specific enzyme immunoassay (EIA) kits having Biodata (Serono, Italy) reagents.
Data Analysis
Mean, SE and coefficients of correlation were calculated. Students t-test was used to study the significance.
RESULTS
In the controls, age ranged form 31 to 52 years with a mean of 40.00 ± 1.66 years. For azoospermics, age ranged from 25 to 45 years with a mean of 34.09 ± 1.11 years.
Semen Characteristics
Semen variables; ie, volume, pH, liquefaction time and WBC count in the controls and azoospermics were statistically compared. The results showed non-significant (p> 0.05) differences regarding all the variables (Table 1).
Hormone Profile
Mean serum levels of fertility hormones assayed in the controls and azoospermics are shown in. All subjects from the control group had normal serum LH, FSH, PRL and T levels compared to normal values given by the laboratory.
Table 2shows significant increase (p< 0.01) in serum LH, highly significant increase (p< 0.001) in serum FSH and highly significant decrease (p< 0.001) in serum T level.
Coefficients of Correlation of Hormones and Semen Volume in the Azoospermics
Table 3 presents coefficients of correlation between various combinations of LH, FSH, PRL, T and semen volume in azoospermics. Statistical analysis shows:
• Significant (p < 0.01) positive correlation between LH vs. FSH.
• Highly significant (p < 0.001) positive correlation between LH vs. PRL.
• Highly significant (p < 0.001) positive correlation between PRLvs. semen volume.
DISCUSSION
In the present study, semen variables and serum hormone levels have been studied in Pakhistanian males and statistically analyzed. These variables are considered essential for the study of infertile patients and their etiological classification (2).
In this study, observed prevalence of azoospermics was higher than the reported data from Greece and Belgium (2,4). Variations are more probably related to differences in the population of patients referred to anyone clinic rather than genuine geographical or temporal variations.
The seminal fluid is composed of secretions from male accessory sex glands and decrease in semen volume reflects disease or malfunction of these glands, such as prostate or seminal vesicle (5). In this study, no significant change was noted in semen volume in azoospermics. pH of less than 7.0 in a semen sample with azoospermia may be an inducator of dysgenesis of vas deferens, seminal vesicle or epididymis and semen normally takes 10 to 20 minutes to liguefy after ejaculation (6). This study reveals no significant change in these variables.
The quantification of WBCs is another integral part of semen analysis, although the relationship between WBCs in semen and male fertility status remains controversial (7). Table 1 shows no significant change in WBC count. A concentration of > 1 x 106 cells/mL of semen is considered to be abnormal, but no study has evaluated whether this threshold is actually predictive in the estimation of one’s chance of achieveng prognancy. However, in such a case microbiological tests should be performed to investigate if there is an accessory gland infection (6).
Hormonal study is helpful in the detection of underlying causes of infertility. Contradictory results published in the literature are probably due to different composition of the types of patients studied, the different hormonal assays used, and essentially different interpretaions of correlation studies (2,8).
The most striking feature was significant increase (p< 0.01) in mean serum LH level and highly significant increase (p< 0.01) in mean serum FSH level in these patients. Elevation of LH and FSH reflects testicular dysfunction that results in an alteration of normal feedback relationships between the testis and the hypothalamus (9). Although there were azoospermics with increased and decreased levels of serum PRL, but, patients with normal levels were more frequent in the present study. Mean serum T level revealed highly significant decrease (p< 0.001) when compared with the controls.
High FSH values are compatible with primary testicular failure (10). In this study, significant positive correlation between serum. LH vs. FSH, in azoospermics confirms that male infertility is associated with elevated levels of both gonadotropins (11).
The role of PRLin male infertility is far from clear. The present study reveals highly significant (p< 0.001) positive correlation between LH vs PRL in azoospermics. Increased PRLlevels are always accompanied by reduced semen volume, but this study showed highly significant (p< 0.001) positive correlation between PRLvs. semen volume (12).
In conclusion, the present data reveals importance of semen and hormonal parameters in the evaluation of infertile males. Serum LH, FSH and T levels seem necessary while PRLis not crucial.
REFERENCES
ADDRESS FOR CORRESPONDENCE:
Samina JALALI, MD
Department of Biological Sciences
Quaid-e-Azam University
Islamabad, PAKHISTAN