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A I Sealfon

Publications and source records attributed to A I Sealfon.

9 recordsLinked to original sources

A theoretical model for testis thermoregulation.

Studies going back as far as the early 1920's show that there is a clear relationship between testis temperature and semen quality. The most intriguing question is whether there is a mechanism of thermoregulation which, in the human, maintains testis temperature within certain limits that permit euspermia. Thermoregulation is defined as maintaining some specified (optimum?) temperature plus or minus an error over internal and ambient loss factors. A computer Model has been evolved which contains no regulation or feedback. It appears to predict human testis temperature data gathered in earlier studies. The Model accounts for countercurrent heat exchange in the pampiniform plexus and predicts, with an open loop analysis, that there is no feedback or regulation. As far as thermoregulation is concerned, there appear to be no first-order effects taking place in the human testis. This suggests that ambient temperature changes cause corresponding changes in testis temperature. Also any internal changes in thermal properties such as core temperature variations or variability of the countercurrent heat exchanger will also cause temperature change. Testis temperature as predicted by this Model is the result of the heat energy entering the testis from arterial inflow minus the venous outflow and heat loss from the scrotum. The Model predicts that the heat exchanger will function to provide precooling of arterial blood as external temperatures drop but will fail to precool effectively as temperature rises. This is predicated on the fact that the countercurrent heat exchanger becomes less effective as the temperature gradient across the exchanger becomes smaller and less heat energy is able to be transferred from arterial flow to venous flow. The Model also predicts that any diminution of the heat exchanger mechanism either from reduced venous flow or restricted scrotal heat loss will result in higher testis temperature. Lastly, the Model correctly predicted that febrile patients would experience elevated testis temperature during periods of elevated core temperature. Since more heat energy is available in the arterial blood, more heat energy is delivered to the testis under these conditions. In the human it appears that any internal or external factor causing a temperature change will not trigger or activate a feedback mechanism to control the resulting testis temperature. A major factor in subfertile semen may be the inability to check excessive temperature of the testis which impairs the ability to produce and mature fertile spermatozoa.

Body Temperature↗

Measurement of intrascrotal temperature in normal and subfertile men.

Intrascrotal temperatures were measured bilaterally by a non-invasive method in 300 subfertile men (mean sperm count 21.4 x 10(6)/ml) and 30 normospermic control men (mean sperm count 118.7 x 10(6)/ml). The subfertile men had mean (s.d.) temperatures of 34.7 degrees C (0.8) for the right and 34.8 degrees C (0.7) for the left testis. The value for both testes of the control men was 33.4 degrees C (0.6). The difference (1.3-1.4 degrees C) was significant (P = 0.03). An intrascrotal temperature of greater than 34.1 degrees C was found in greater than 83% of subfertile men, regardless of clinical diagnosis. This method can therefore be used to survey large numbers of men. We suggest that small intrinsic temperature increases may interfere with the ability of the testis to accommodate to environmental temperature stresses and so lead to abnormal semen and subfertility.

Body Temperature↗

Chronic scrotal hypothermia: results in 90 infertile couples.

We studied the use of a testicular hypothermia device worn daily for at least 16 weeks in 64 men with subfertile semen and elevated testicular temperature, who had had an infertile marriage for 2 or more years in which the wife was judged fertile. Improvement in 1 or more semen parameters was seen in 42 patients (65.6 per cent). Semen analysis was converted into the motile oval index, a numerical value representing the count, motility and normal morphology. The motile oval index helps to predict pregnancy outcome. Of 21 patients with pre-treatment motile oval indexes greater than 4.8 million per ml. 11 (52.4 per cent) produced pregnancy. Patients with lower starting indexes did not fare as well. Of 20 patients who met the criteria, and who wore the device for less than 2 weeks or not at all and had no other treatment 1 (5.0 per cent) produced pregnancy. Mean hypothermia time to date of missed menses was 4.2 months. Six patients with nonobstructive azoospermia showed no semen change with the testicular hypothermia device.

Female↗

Scrotal hypothermia: new therapy for poor semen.

A relation between experimental elevation of testis temperature and poor semen has been known for over sixty years. Poor semen from elevated temperature due to intrinsic abnormality of testis thermoregulation has been a recent concept. A testicular hypothermia device (THD) was created which when worn by "hard core" infertile males with varicocele, failed varicocelectomy, or "subclinical" varicocele resulted in lowering of temperature with improvement in semen in many. Pregnancies have resulted. The device is noninvasive and well tolerated.

Body Temperature Regulation↗

Further clinical experience with testis hypothermia for infertility due to poor semen.

Chronic scrotal hypothermia to 25 patients with infertility and elevated testis temperature resulted in varying degrees of improvement over their pretreatment poor semen in 16/25. Pregnancy occurred in 6/25 "hard core" infertile couples (mean period of infertility 6.0 years) after wearing an evaporative scrotal cooling device for sixteen hours daily for a mean of 14.5 weeks. The offspring of such hypothermia-treated fathers appear to be normal. Varicocele, failed varicocelectomy, and "idiopathic infertility" are conditions suitable for such noninvasive hypothermic treatment. Discontinuance of hypothermia resulted in a return to pretreatment poor semen. Elevated temperature plays a role in poor semen.

Humans↗

Chronic scrotal hypothermia as a treatment for poor semen quality.

Six men with infertile marriages associated with poor semen and raised testicular temperature were treated by an experimental appliance which exploits evaporation to obtain normal testicular temperatures. This was worn with little discomfort for as long as 24 h a day and for periods as long as 20 weeks. Three wives became pregnant while their husbands were on treatment. Semen analysis at the time of the missed menses showed improvements in all three men. In two patients who did not achieve a pregnancy, semen improvements were also seen after 12 weeks. The improvements in semen quality cannot be attributed to any agency other than the hypothermia; this strengthens the theory that raised temperature plays a role in male infertility. Scrotal hypothermia seems to be a suitable treatment in men with varicocele, varicocelectomy failure, and idiopathic infertility where intrascrotal temperature is raised.

Adult↗