Gn RH test: prognostic significance in different testicular pathological patterns.
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Biomedical subjects
Publications and source records attributed to I Noci.
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The purpose of this research has been to value the importance of chronic inflammation of the prostatovesicular apparatus in sterile patients. The authors wish to underline the high incidence of chronic inflammation if this apparatus in such patients, the low incidence of bacterial forms and the high frequence of association with bradycinesia. The therapy of such forms gives excellent results.
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A rare case of male internal pseudohermaphroditism is described. The patient had normal external male sexual characteristics but unilateral cryptorchidism. Three of his brothers had also cryptorchidism. The patient's parents were cousins. The patient's karyotype was normal.
The therapeutic value of Direct Intraperitoneal Insemination (DIPI) is of particular interest in cases of unexplained infertility and failed AID. The same technique is less likely to be successful where functional or morphological semen abnormalities or multifactorial infertility exist. The Authors report their own experience with DIPI as a treatment on 76 couples with a long-standing infertility.
A number of experimental data indicate that hyperprolactinemia inhibits the activity of 5-alpha-reductase; however, no information is available about the time required for this enzyme to re-activate after prolactinemia has returned to normal values. In the present study, five normal caucasian men, whose fertility had previously been proven, were given HCG (5000 IU/day by intramuscular route for three days) both in basal conditions and after sulpiride-induced hyperprolactinemia (dosage = 200 mg/day for ten days). In both conditions, the plasma levels of prolactin (PRL), testosterone (T), dihydro-testosterone (DHT), 17-beta-estradiol (E2), and dehydroepiandrosterone sulfate (DHAS) were monitored during the treatment with HCG and for an additional 24 hrs after HCG discontinuation. All hormones were assayed by RIA. Our results demonstrate that hyperprolactinemia causes a marked decrease (58%) of DHT, a less marked decrease (39%) of T, an increase (43%) of DHAS whereas only a small increase (2%) of E2 was observed. Steroids were shown to behave differently after the HCG tests performed in the two experimental conditions. In particular, the levels of DHT had a much more pronounced increased after HCG in the second test than in the first; in contrast, both DHAS and E2 had a less marked response after the second test. Our data, on the one hand, confirm that 5-alpha-reductase is inhibited by hyperprolactinemia; on the other hand, the hyperprolactinemia-induced block of this enzyme appears to be rapidly reversible because the enzyme is reactivated within 48-72 hrs after normalization of prolactin levels. (Normal values of prolactin were on the average achieved on the 4th day after sulpiride discontinuation).(ABSTRACT TRUNCATED AT 250 WORDS)
New urinary tests of pregnancy have recently been developed that are exceptionally sensitive to HCG. Our study was undertaken to explore the possibility that exogenous HCG, administered to induce ovulation, may interfere with these low-threshold tests of pregnancy. Six healthy volunteers participated in our study. Each woman received three sequential 5,000-U doses of HCG by im route on days 3, 5, and 7 after ovulation. Blood and urine for HCG assay were taken daily from each subject. Urine specimens were subjected to a traditional high-threshold pregnancy test (sensitivity limit = 2000 U/L) and to a low-threshold pregnancy test (sensitivity limit = 50 U/L); HCG in plasma and urine was determined by ELISA assay. Plasma HCG levels increased gradually under HCG dosing and attained a peak on day 8 (average = 73.7 U/L; range 24-124 U/L). As regards urinary HCG levels, the average value on days 8, 9, and 10 was above the 50-U/L detection limit of the low-threshold test, which was in fact positive in the majority of patients. Also on days 11 and 12, however, urinary HCG levels were above this limit in a certain proportion of subjects (day 11, 2/6; day 12, 1/6); accordingly the low-threshold pregnancy test was positive with a frequency of 2/6 on day 11 and of 1/6 on day 12. By contrast, the traditional high-threshold pregnancy test was negative in urine samples of all subjects. Our study indicates that the increased sensitivity of modern low-threshold pregnancy tests may cause false positive results in those cases where exogenous HCG has been administered during the luteinic phase.
The role of hysteroscopy for a complete evaluation of luteal phase is discussed by the authors. They affirm that for a thorough evaluation a hysteroscopy may be usefully performed simultaneously to the endometrial biopsy.
A comparison between hysterosalpingography and hysteroscopy in the evaluation of tubal ostium pathology is presented by the authors. They stress in particular the role of hysteroscopy in this evaluation.
We report our experience with artificial insemination with husband's semen (AIH) using cervical cap. Forty-four couples were admitted to our AIH program over a two-year period. In 4 couples, AIH was performed due to impotence or hypospadia, while in the remaining 40 couples indications for AIH were abnormal semen, poor post-coital test, anti-sperm antibodies, poor cervical mucus. Overall, six pregnancies were obtained (pregnancy rate = 15%) in the latter group; in particular, AIH was able to elicit pregnancy in 5 out of the 25 cases of abnormal semen (20%). Our data emphasize the importance of female factors associated with infertility since significantly higher pregnancy rates (45.4% versus 0%) were observed in subjects in whom these factors were absent.
Of the many people currently infertile, at least 40% have a problem related solely to the male. Feelings about infertility are based on something deeper and more engrained in a person's character called concepts. Concepts are formed by many forces such as religion, society, the value of others and so on. 61 males, partners of infertile couples, were invited to an interview using as a means of investigation a semistructured questionnaire. We focused our attention on the meaning these men gave to an eventual baby, and on the common opinion about a childless married man either from a social or an individual point of view. According to these criteria, we found that 42% of the people interviewed thought that "people" consider the lack of children as related to male impotence with remarkable differences between the opinion of those who lived in cities and those who did not. As for the solution prospected in the case of incurable sterility, 37% would chose to remain childless, a little lower percentage would choose a sperm bank and only 20% would choose adoption. The results of this research show that among many different aspects, the image of the baby for these applicant fathers is still linked to traditional values.
The mixed antiglobulin reaction was developed for detection of platelet antibody and then modified to demonstrate antibodies on spermatozoa. We have used the test as a simple method of screening for antibodies in the male, performing the test during the analysis of semen samples. We evaluated 320 samples from partners of sterile couples attending our Sterility centers. The IgG MAR test was not applicable to 82 samples because the sperm concentration and sperm motility was not sufficient. In all uncertain, positive and firmly positive cases of MAR test and in 50 negative cases of IgG MAR test, as control group we performed MAR test for IgA. We correlate our results with the sperm test penetration, SCMC test and identification of antisperm antibodies test and Isojima test for sperm immobilizing antibodies. Our results reconfirm the utility of IgG MAR test as screening test for the presence of antibodies but its positiveness requires the performance of IgA MAR test and, if necessary, of other tests in order to diagnose sterility depending on immunologic factors.
We studied the statistical distribution of the plasma concentrations of FSH and testosterone in patients with oligoazoospermia as compared with normospermic subjects. The plasma concentration of FSH was determined in 429 patients with oligoazoospermia and 282 normospermic subjects ("controls"). In 118 out of these 429 patients and in 47 of the 282 controls, the plasma concentration of testosterone was also measured. The plasma concentrations of FSH differed significantly depending on the patients' values of spermatic concentration. The most significant difference was observed between azoospermic patients and controls, whereas the difference between patients with mild oligospermia and controls was not significant. Conversely, the plasma concentrations of testosterone did not correlate with the values of spermatic concentration and even the difference between azoospermic patients and controls did not reach the significance level. In addition, testosterone plasma concentrations did not differ between two sub-groups of patients who were defined depending on whether the plasma concentration of FSH was normal or high. Our findings confirm the inverse relation between plasma FSH levels and spermatic concentration which had already been observed in previous studies. However, a considerable overlap in the plasma concentrations of FSH has been found between sub-groups of patients with different spermatic concentrations. This overlap limits the clinical usefulness of the measurement of FSH concentration inasmuch as normal FSH plasma levels may often be associated with any value of spermatic concentration. Also, our data confirm that the measurement of testosterone plasma levels provides little clinical usefulness in male infertile patients.
In the past years, hypothalamic phospholipids (H-PL) have been used therapeutically for their behavioral effects. The major pharmacological effect of H-PLs is that they increase the turnover rate of biogenic amines in the brain. Previous studies have also shown that a single i.v. dose of H-PL may influence tha plasma levels of gonadotropins, prolactin (PRL) and growth hormone (GH). Since data have not yet been published concerning the effects, if any, of chronic i.m. administration of H-PL on the ovarian function, the present study was undertaken to gain insight into this issue. Four women were studied. Each subject was given H-PLs by i.m. injection from the 5th to the 20th day of the cycle at the dose of 100 mg/day. Blood samples were repeatedly taken over this period to measure the plasma concentrations of FSH, LH, E2, PRL, and progesterone. GH administration, no side-effects were noted in any of the subjects studied. All subjects presented normal plasma levels of FSH, LH, E2, PRL, and progesterone. GH demonstrated some upward fluctuations, which always regressed rapidly. Our findings demonstrate that chronic H-PL administration at therapeutic doses does not influence the ovarian cycle in women. In the light of our data, it appears that different hormonal effects are elicited by a single i.v. high-dose administration of H-PLs as compared with those produced by chronic i.m. treatment at therapeutic doses.
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Dynamic echohysteroscopy is a new diagnostic method which can be applied to the clinical problems of infertility, providing informations on the morphology of the internal genitals. The Authors underline the clinical validity of this diagnostic technique, even though more experience is required in order to define a better standardization of the method.