The prescription and proscription of chorionic gonadotropin.
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Biomedical subjects
Publications and source records attributed to R D Amelar.
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It now appears that the incidence of bilateral varicoceles in infertile men with varicocele may be around 50 per cent to 60 per cent. Infertile men should be examined carefully for varicoceles on both sides, and bilateral varicocelectomy should be performed when indicated. Furthermore, we have demonstrated that selected infertile patients who have failed to improve after left varicocelectomy may yet improve after correction of the right varicocele.
In the past 8 years we found 41 infertile men with poor semen quality in whom an overlooked right varicocele might have been the reason for failure to improve after previous left varicocelectomy. None had ever fathered a child. After we performed sequential right varicocelectomy in these 41 patients, semen quality improved in 23 (56%). Twenty-seven pregnancies have been achieved to date by the wives of 18 (43%) of the patients whose semen improved. No pregnancies were caused by those whose semen failed to improve. Infertile men should be carefully examined for varicoceles on both sides, and bilateral varicocelectomy should be performed when indicated. Selected infertile patients who have failed to improve after left varicocelectomy and are found subsequently to have a right varicocele may yet improve following correction of the right varicocele.
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Relaxin and prostaglandin E2 (PGE2) are present in human semen and have been shown to affect sperm motility. The authors further examined the effects of porcine relaxin and PGE2 on the motility of human spermatozoa. A dose-response study revealed that PGE2 at a concentration of 25 micrograms/ml is most effective in improving the motility of washed human sperm. Relaxin (100 ng/ml), PGE2 (25 micrograms/ml), or the two combined have no effect on the motility of spermatozoa in fresh, normal semen, suggesting that the constituents of fresh semen are optimal for motility. Relaxin and PGE2 individually improve the motility of washed spermatozoa. However, relaxin, but not PGE2, improves the motility of sperm in semen incubated at 37 degrees C for 5 hours (aged). In contrast to the individual substances, a combination of relaxin + PGE2 has no effect on the motility of washed spermatozoa or aged spermatozoa, suggesting that these two substances antagonize each other's actions on sperm motility. The presence of both relaxin and PGE2 in seminal plasma with normal motility spermatozoa suggests that other factors in seminal plasma regulate the effects of these substances on sperm motility.
To study its effect on the motility of human spermatozoa, relaxin was added at different concentrations to human semen samples of various qualities as well as to washed spermatozoa. Relaxin in physiologic concentrations (10-100 ng/mL) had no significant effect on sperm motility in normal semen samples. However, the addition of relaxin to semen samples with low sperm motility significantly increased the motility. Addition of relaxin similarly increased the motility of spermatozoa from normal semen samples that were either aged or washed; the treatment resulted in a decrease in motility. When sperm motility was optimal, as in normal samples, addition of relaxin did not increase motility. However, in some situations of decreased motility, addition of relaxin resulted in improvement of spermatozoan motility. Relaxin may have clinical value in the treatment of male infertility.
Two previously fertile males have requested surgical vasectomy reversal after divorce and failure of their new younger wives to conceive by repeated inseminations with their stored frozen semen. The sperm had been preserved for six and five years, respectively, as "fertility insurance" prior to sterilization by bilateral vasectomy. It is clear that the storage of fertile semen does not guarantee future fertility.
Polyzoospermia is a rare cause of male infertility. In our clinical practice, patients with exceedingly high sperm counts (ranging from 650 million/ml to 1.75 billion/ml) have invariably been found to have associated poor sperm motility and poor sperm migration in postcoital tests, although the sperm appear morphologically normal. Cases of two infertile couples are presented in which each husband had sperm counts greater than 1 billion/ml. Two methods are reported for the successful management of their infertility problems: (1) precoital dilutional douching and (2) in vitro seminal fluid dilution with 5% dextrose-Ringer's lactate solution and artificial insemination homologous. Each method resulted in improved sperm motility, postcoital tests, and pregnancy.
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Fructose, zinc, and prolactin determinations were performed on the seminal plasma of normospermic (n = 30), oligospermic (n = 30), and azoospermic (n = 30) men to determine whether there was a correlation between any of these substances and seminal quality. None of these azoospermic men had congenital bilateral absence of the vasa, but in a separate group of such men (n = 10) these same studies were performed. Fructose was determined photometrically, zinc by atomic absorption, and prolactin by radioimmunoassay. Zinc and fructose levels in all three groups showed no statistical differences. Prolactin was found to be significantly higher in the seminal plasma of normospermic men than was found in the seminal plasma of oligospermic or azoospermic men. In men with congenital bilateral absence of the vasa and seminal vesicles, zinc was elevated, fructose was absent, and prolactin was markedly depressed.
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Six hundred male patients were examined for circulating spermagglutinating antibodies by the Kibrick sperm-agglutination test and 20% demonstrated autoantibodies. The high incidence of positive findings may be explained by the select population studied. Of 80 men tested who demonstrated more than 10% agglutination in their semen, but were otherwise normospermic, 41% demonstrated positive titers by the Kibrick method. Of 300 men examined for circulating sperm-immobilizing antibodies by the Isojima sperm-immobilizing test, 6% had autoantibodies. This high incidence of positive findings demonstrates the need for these tests in males who otherwise appear normospermic or demonstrate an unexplained infertility.