Medical implications of the male biological clock.
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Adult↗
Biomedical subjects
Harry Fisch
Publications and source records attributed to Harry Fisch.
Management of ejaculatory duct obstruction: etiology, diagnosis, and treatment.
Abnormalities of the distal ejaculatory ducts related to infertility have been well-documented. Although there are no specific findings associated with ejaculatory duct obstruction, several clinical findings are highly suggestive. A diagnosis of ejaculatory duct obstruction is suggested in an infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex characteristics, testes, and hormonal profile, and dilated seminal vesicles, midline cyst, or calcifications on TRUS. Other causes of infertility may be concomitantly present and need to be evaluated and treated. Trans urethral resection of ejaculatory ducts (TURED) has resulted in marked improvement in semen parameters, and pregnancies have been achieved. Proper patient selection and surgical experience are necessary to obtain optimal results. In case of testicular dysfunction, chances of success are minimal. Extended follow-up periods are needed after TURED to examine the long-term effects of this procedure. Better understanding of the anatomy and pathology of the ejaculatory ducts will continue to refine diagnostic and therapeutic procedures for this disorder.
Constriction, Pathologic↗
The male biological clock.
Do men have biological clocks that affect their hormone levels, fertility, and the genetic quality of their sperm? Women can no longer be viewed as solely responsible for age-related fertility and genetic problems. The effects of andropause and advanced paternal age on fertility and offspring are still under investigation. Further research is needed to fully characterize the associated risks and to treat the underlying abnormalities. A better understanding of the cellular and biochemical mechanisms of "gonadal" aging is important in order to determine safe, effective ways to delay this process and "rewind" the male biological clock. The benefits may include decreasing the potential for adverse genetic consequences in offspring, improvement in the sexual and reproductive health of aging males, and increase a woman's chance of having healthy children by correcting defects in the male reproductive system.
Aging↗
Hypogonadism and metabolic syndrome: implications for testosterone therapy.
PURPOSE: Metabolic syndrome, characterized by central obesity, insulin resistance, dyslipidemia and hypertension, is highly prevalent in the United States. When left untreated, it significantly increases the risk of diabetes mellitus and cardiovascular disease. It has been suggested that hypogonadism may be an additional component of metabolic syndrome. This has potential implications for the treatment of metabolic syndrome with testosterone. We reviewed the available literature on metabolic syndrome and hypogonadism with a particular focus on testosterone therapy. MATERIALS AND METHODS: A comprehensive MEDLINE review of the world literature from 1988 to 2004 on hypogonadism, testosterone and metabolic syndrome was performed. RESULTS: Observational data suggest that metabolic syndrome is strongly associated with hypogonadism in men. Multiple interventional studies have shown that exogenous testosterone has a favorable impact on body mass, insulin secretion and sensitivity, lipid profile and blood pressure, which are the parameters most often disturbed in metabolic syndrome. CONCLUSIONS: Hypogonadism is likely a fundamental component of metabolic syndrome. Testosterone therapy may not only treat hypogonadism, but may also have tremendous potential to slow or halt the progression from metabolic syndrome to overt diabetes or cardiovascular disease via beneficial effects on insulin regulation, lipid profile and blood pressure. Furthermore, the use of testosterone to treat metabolic syndrome may also lead to the prevention of urological complications commonly associated with these chronic disease states, such as neurogenic bladder and erectile dysfunction. Physicians must be mindful to evaluate hypogonadism in all men diagnosed with metabolic syndrome as well as metabolic syndrome in all men diagnosed with hypogonadism. Future research in the form of randomized clinical trials should focus on further defining the role of testosterone for metabolic syndrome.
Adult↗
Transurethral resection of the ejaculatory ducts for treating ejaculatory symptoms.
OBJECTIVES: To report our experience with transurethral resection of the ejaculatory ducts (TURED) in infertile men with symptomatic ejaculatory duct obstruction (EDO). PATIENTS AND METHODS: Before surgery, all patients complained of a decrease in the volume of their ejaculate, 14 of 15 had a non-projectile ejaculation, nine had a genitourinary infection necessitating antibiotic treatment, and five had pain with orgasm. The mean ejaculate volume and total motile sperm count was 1.1 mL and 8.1 million sperm per ejaculate. After surgery, at a mean follow-up of 2 months, 10 men reported having projectile ejaculation, and eight reported a marked improvement in their sensation of orgasm. Overall, 14 men reported a subjective improvement in their ejaculation. The average postoperative ejaculate volume was 2.3 mL and the total motile sperm count was 38.1 million per ejaculate. CONCLUSIONS: Men with symptomatic EDO who underwent TURED showed improvements in their ejaculation, sensation of orgasm, semen analysis values and fertility.
Constriction, Pathologic↗
Clomiphene citrate effects on testosterone/estrogen ratio in male hypogonadism.
AIM: Symptomatic late-onset hypogonadism is associated not only with a decline in serum testosterone, but also with a rise in serum estradiol. These endocrine changes negatively affect libido, sexual function, mood, behavior, lean body mass, and bone density. Currently, the most common treatment is exogenous testosterone therapy. This treatment can be associated with skin irritation, gynecomastia, nipple tenderness, testicular atrophy, and decline in sperm counts. In this study we investigated the efficacy of clomiphene citrate in the treatment of hypogonadism with the objectives of raising endogenous serum testosterone (T) and improving the testosterone/estrogen (T/E) ratio. METHODS: Our cohort consisted of 36 Caucasian men with hypogonadism defined as serum testosterone level less than 300 ng/dL. Each patient was treated with a daily dose of 25 mg clomiphene citrate and followed prospectively. Analysis of baseline and follow-up serum levels of testosterone and estradiol levels were performed. RESULTS: The mean age was 39 years, and the mean pretreatment testosterone and estrogen levels were 247.6 +/- 39.8 ng/dL and 32.3 +/- 10.9, respectively. By the first follow-up visit (4-6 weeks), the mean testosterone level rose to 610.0 +/- 178.6 ng/dL (P < 0.00001). Moreover, the T/E ratio improved from 8.7 to 14.2 (P < 0.001). There were no side effects reported by the patients. CONCLUSIONS: Low dose clomiphene citrate is effective in elevating serum testosterone levels and improving the testosterone/estradiol ratio in men with hypogonadism. This therapy represents an alternative to testosterone therapy by stimulating the endogenous androgen production pathway.
Adult↗
A novel surgical approach to subinguinal varicocelectomy: artery and lymphatic isolation technique.
Clinically relevant varicoceles require surgical management through one of several techniques. We introduce an innovative technique for varicocelectomy via a subinguinal approach that allows identification and preservation of the arteries and lymphatics. This method allows the safe excision of the varicocele, while minimizing the risk of complications.
Humans↗
[Quality evaluation of three different sperm counting chambers].
OBJECTIVE: Semen evaluation is the most important laboratory test for assessing male fertility. However, lack of strict quality control (QC) for semen analyses in hospital andrology laboratories makes it difficult and meaningless to compare semen data between different laboratories. This paper reports a comparative study on the accuracy of the Hemacytometer (Qiujing Inc., Shanghai, China), Makler (Sefi-Medical Instrument, Haifa, Israel), and Cell-VU (Millennium Sciences Inc., New York, USA) chambers for sperm counting. METHODS: Both low [(18 +/- 2.5) x 10(6)/ml] and high [(35 +/- 5) x 10(6)/ml] pre-calibrated standard latex bead solutions (Hamilton Thorne Biosciences, USA) were used as the quality control solution to perform counts on the three different counting chambers. Bead counts for the three different chambers were compared, and variability within the chambers determined for standard solutions at low and high concentrations of latex beads, respectively. RESULTS: Mean bead concentrations for the Cell-VU, Hemacytometer and Makler chambers were (37.63 +/- 4.89), (42.74 +/- 4.98) and (53.52 +/- 6.67) x 10(6)/ml respectively for a standard solution containing (35 +/- 5) x 10(6) beads/ml, and (18.22 +/- 1.77), (20.48 +/- 1.56), (24.97 +/- 4.75) x 10(6)/ml respectively for a standard solution containing (18 +/- 2.5) x 10(6) beads/ml. Mean bead concentrations for the Cell-VU chamber were consistently similar and close to the standard pre-calibrated bead solutions, while those for both the Hemacytometer and the Makler chambers were significantly overestimated (P < 0.001). The average coefficients of variation for the Cell-VU chamber were 7.51% for a higher concentration of the standard solution containing (36 +/- 5) x 10(6) beads/ml and 1.22% for a lower concentration of the standard solution containing (18 +/- 2.5) x 10(6) beads/ml, while the mean variation rates of the Hemacytometer and Makler chambers were 22.11% and 13.78% for a standard solution containing (36 +/- 5) x 10(6) beads/ml, and 52.91% and 38.72% for a standard solution containing (18 +/- 2.5) x 10(6) beads/ ml, respectively. CONCLUSION: Semen analysis is one of the most important tests for male fertility evaluation, but the data obtained from commercially available counting chambers may differ markedly in accuracy and reliability. Results from this comparative study demonstrated that the Cell-VU chamber exhibits significantly more accurate and less variable results than those of the Hemacytometer and Makler chambers. To ensure the best possible evaluations and accurate diagnoses, we therefore recommend that Cell-VU be used as the standard counting chamber for routine semen analyses in andrology laboratories.
Blood Cell Count↗
The relationship of long term global temperature change and human fertility.
UNLABELLED: According to the United Nations, global fertility has declined in the last century as reflected by a decline in birth rates. The earth's surface air temperature has increased considerably and is referred to as global warming. Since changes in temperature are well known to influence fertility we sought to determine if a statistical relationship exists between long-term changes in global air temperatures and birth rates. The most complete and reliable birth rate data in the 20th century was available in 19 industrialized countries. Using bivariate and multiple regression analysis, we compared yearly birth rates from these countries to global air temperatures from 1900 to 1994.A common pattern of change in birth rates was noted for the 19 industrialized countries studied. In general, birth rates declined markedly throughout the century except during the baby boom period of approximately 1940 to 1964. An inverse relationship was found between changes in global temperatures and birth rates in all 19 countries. Controlling for the linear yearly decline in birth rates over time, this relationship remained statistically significant for all the 19 countries in aggregate and in seven countries individually (p<0.05). CONCLUSIONS: The results of our analyses are consistent with the underlying premise that temperature change affects fertility and suggests that human fertility may have been influenced by change in environmental temperatures.
Birth Rate↗
The influence of paternal age on down syndrome.
PURPOSE: Children born to older parents are at greater risk for genetic abnormalities, such as Down syndrome. The influence of maternal age on Down syndrome is well established but little is known about the genetic consequences of advanced paternal age. MATERIALS AND METHODS: Data on the incidence of Down syndrome from 1983 to 1997 (3,419 cases) were obtained from the New York State Department of Health congenital malformations registry. Parental age was modeled as individual age groups and by a single linear covariate (drift model). The log linear chi-square test and a test of significance of different explanatory variables were used to evaluate these models to determine significance. We compared actual Down syndrome rates by maternal age with the estimated rate corrected for paternal age. RESULTS: From 1983 to 1997 a dramatic increase in the number of infants born to parents 35 years or older was observed. During the 15-year study period there was an increase of 111% and 60% in the number of mothers and fathers 35 years old or older, respectively. There was no parental age influence on Down syndrome until age 35 years and older. A paternal age effect was seen in association with a maternal age of 35 years and older, and it was most pronounced when maternal age was 40 years and older (p = 0.0004). In this later maternal age group the paternal contribution to Down syndrome was 50%. CONCLUSIONS: Advanced paternal age combined with maternal age significantly influences the incidence of Down syndrome. This effect may represent a paradigm for other genetic abnormalities in children of older fathers.
Adult↗
Ejaculatory duct obstruction.
PURPOSE OF REVIEW: We surveyed the growing literature on ejaculatory duct obstruction and provide suggestions regarding its diagnosis and management. RECENT FINDINGS: Ejaculatory duct obstruction is a rare cause of male infertility. With the advent of the high resolution transurethral ultrasound (TRUS) technology, there has been an increase in diagnosis of this disorder. As for the treatment, it appears that central cystic lesions and partial obstructions respond best to transurethral resection of the ejaculatory ducts (TURED). SUMMARY: Ejaculatory duct obstruction is a rare but surgically correctable cause of male infertility. Although there are no pathognomonic findings associated with ejaculatory duct obstruction, the diagnosis should be suspected in an infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex characteristics, testes, and hormonal profile, and dilated seminal vesicles, midline cyst, or calcifications on TRUS. In select cases, TURED has resulted in marked improvement in semen parameters, and pregnancies have been achieved. More studies are needed in the areas of diagnosis and long-term surgical outcome.
Constriction, Pathologic↗
The natural history of partial ejaculatory duct obstruction.
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Adult↗