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Immunological consequences of vasectomy: I. Prospective study through one-year postvasecotomy.

Autoimmunity to sperm developed in two-thirds of men within 1 year after vasectomy as measured by sperm agglutinating and sperm immobilizing antibody tests. Sperm antibody responses to vasectomy were greater in younger than in older men. A direct relationship was apparent between increasing incidence of sperm immobilizing antibody and genetic predisposition to autoimmune disease. Some vasectomized men developed immune responses to autoantigens other than spermatozoa. Increased antithyroglobulin activity was evenly divided between patients who formed sperm antibody and those who did not. Antinuclear activity was more frequent in patients who were sperm antibody responders.

Adult

Comparison of allergic aspermatogenesis with that induced by vasectomy. II. In vitro studies of cell-mediated immunity to sperm after vasectomy in man and guinea-pig.

Transformation of peripheral blood leucocytes was shown to be a valid assay for cell-mediated immunity to sperm in male guinea-pigs immunized with homologous epididymal sperm (ES) in FCA. A heat-treated extract of ES (BES) was used for culture. Possible developement of cell-mediated immunity to sperm after vasectomy was investigated in patients and guinea-pigs, by culture of blood leucocytes before and at intervals after operation. Patients' leucocytes were cultured with a heat-treated extract of human seminal sperm (BHS); guinea-pigs' leucocytes were cultured with BES. These cultures showed no evidence of specific stimulation of leucocytes by sperm extract, up to 1 year after vasectomy in patients, or up to 6 months in guinea-pigs. Similarly, no evidence of delayed hypersensitivity could be demonstrated by skin tests with BES in animals vasectomized 1 year previously. We consider that this study establishes that cell-mediated immunity to sperm does not develop in either man or guinea-pigs, up to 1 year after conventional vasectomy.

Animals

Quantitative study of spermatogenesis in vasectomized mice.

Adult mice were vasectomized under semi-sterile conditions and examined five weeks later. The weight of the epididymis was increased but none of the animals had developed spermatic granulomas. The concentration of testosterone in the plasma, the body weight and the weight of the testes were not affected by vasectomy. Cross sections of the testes were prepared for histological examination and the nuclei of the various types of germinal cells were enumerated at stage VII of spermatogenesis. Vasectomy caused a small, but statistically significant, decrease in the number of preleptotene spermatocytes, pachytene spermatocytes and step 7 spermatids.

Animals

Comparison of allergic aspermatogenesis with that induced by vasectomy. I. In vivo studies in the guinea-pig.

Groups of male and female guinea-pigs were immunized with homologous epdidymal sperm in Freund's complete adjuvant (FCA) and skin tested at weekly intervals with a heat-treated extract of the sperm or with PPD. In females, the skin response to both antigens was similar to that to any standard protein antigen. In males, the response to sperm extract varied with the induced auto-immune orchitis, reaching a maximum immediately after testis lesion was most severe and as recovery was beginning (shown histologically): the response to PPD was decreased at 1 week after immunization, but subsequently was similar to that in females. Skin tests on guinea-pigs 8 months after bilateral vasectomy (when both ends of vasa were ligated), showed no evidence of delayed hypersensitivity to sperm, although there was marked histological evidence of reduced spermatognesis, due to back pressure atrophy.

Animals

Vasectomy: a long-term study of its effects on testicular endocrine function in man.

Plasma testosterone, luteinizing hormone (L.H.) and follicle stimulating (F.S.H.) were measured before operation in 39 males, aged 26 to 53 years with 2 to 5 children, seeking vasectomy for contraceptive purposes. These measurements were repeated at 3 and 12 months after vasectomy. Levels of L.H. at 12 months were significantly higher than pre-vasectomy levels, suggesting some degree of decreased Leydig cell function. However, testosterone and F.S.H. levels were similar at the three sampling times. Continuing yearly measurements for at least 5 years are planned.

Adult

Determinantion of testosterone concentration in semen of men with normal or subnormal sperm counts and after vasectomy.

Semen from 58 male subjects, aged 22 to 50, was assayed on an individual basis to determine whether T was present in it. Of the subjects examined 23 were normospermic, 14 oligospermic and 9 azoospermic; 12 men had undergone vasectomy were also included in the study. In 39 of the subjects plasma testosterone was estimated. A competitive protein binding technique was employed for T assays while dried extracts of semen were examined by combined gas-chromatography-mass spectrometry and mass fragmentography. Measurable amounts of T were detected in all seminal specimens assayed. This was confirmed by gas chromatography-mass spectrometry which showed a spectrum suggestive of T. The ratio of unconjugated to conjugated steroid in semen was found to be approximately 1:10. Levels of unconjgated T were similar to those found in plasma of normally menstruating women. The mean seminal concentration of unconjugated T (+/-SD) in the specimens assayed was 0.71 ng/ml+/-0.08 for the normospermic, 0.79+/-0.14 for the ezoospermic, 0.69+/-0.09 for the oligospermic, but only 0.38+/-0.04 for the vasectomized subjects. Plasma levels for this androgen were within the range found in normal men of comparable age. Significant correlation between plasma and seminal T concentration could not be demonstrated and there was no correlation between either of the above parameters and the seminal volume, the number, abnormal form percentage and the motility of spermatozooa in the normo--or oligospermic group. However, when the two groups were pooled into one, significant correlations were found between plasma, (but not seminal T concentration) and the seminal characters examined, perhaps suggesting the number of specimens from the groups should be increased to obtain valid data. Administration of human chorionic gonadotropin produced a marked plasma response as well as a rise of seminal T levels in 3 normospermic subjects whereas cyproterone acetate caused reduction of plasm T levels but had no consistent effect on the seminal concentration of ts steroid although the sensitivity of the seminal method may not have detected smaller changes at this level.

Adult

Vasectomy and vasovasostomy. I. Timing of histologic changes in immature and mature dog testis after vasectomy.

The effects of vasectomy on the development and maintenance of spermatogenesis was studied using immature and mature dog testes. Bilateral vasectomy in immature dogs delayed the development of advanced spermatocytes, spermatids, and spermatozoa for about 3 months postsurgery. Spermatogenesis appeared to be recovered to control levels by 4 months postvasectomy. Spermatogenesis in mature dogs was also altered after bilateral vasectomy. Decreased numbers of advanced spermatocytes as well as maturation arrest was observed by 3 weeks postvasectomy. Seminiferous tubule cell layers quickly decreased to one to three layers as the lumina became occluded with sloughed cells by 3 to 6 weeks postvasectomy. Recovery in terms of the numbers of spermatocytes, spermatids, and spermatozoa was evident by 13 weeks postvasectomy, although occasional dog testes did not recover and appeared to be more sensitive to vasectomy-induced damage. It thus appears that vasectomy temporarily inhibits both the development and maintenance of spermatogenesis in immature as well as mature dog testes. Spermatogenesis does recover but may be maintained at somewhat lower levels after vasectomy. Changes are rapid in onset and take several weeks to be reversed. Some dog testes appear to be more sensitive to the damage and it may be irreversible in these testes.

Animals

The effects of vasectomy on viscosity, pH and volume of semen in man.

The effects of vasectomy on seminal viscosity, volume and pH have been investigated in freshly emitted semen of 21 healthy men before operation and three months later. Viscosity and the pH range were decreased significantly, but the decrease of the seminal volume was not significant. Reasons of changes have been discussed.

Adult

Consequences of vasectomy: an immunological and histological study related to subsequent fertility.

Studies of 2 groups of patients 2 years and 8 years following vasectomy failed to demonstrate evidence of cell mediated immunity to sperm. Histological examination of testicular tissue from 11 patients undergoing reversal of vasectomy showed significant abnormalities in each. However, subsequent fertility within 15 months occurred in 7 (63.6%) of these patients. The nature of the testicular changes and the possible aetiological factors are discussed.

Adult

Gonadal function following vasectomy in the rat.

Adult rats were studied at four, eight, and 12 months following vasectomy and sham-operation. The weights of the seminal vesicles, ventral prostate, pituitary, and kidneys were not significantly affected by vasectomy. Testicular endocrine function in vasectotomized rat was transiently stimulated as witnessed by elevation in testicular venous testosterone and androstenedione after four months. There then occurred signs of decline in gametogenic function and atrophy of the testis after 12 months whereas hormonogenesis appeared to remain at normal levels. There was no alteration in the morphology of the epididymis at any of the time intervals of study after vasectomy.

Animals

Seminal fructose and acid phosphatase in vasectomised men.

Seminal fructose and acid phosphatase levels have been determined in 30 vasectomised and 30 nonvasectomised healthy adults, both the groups being closely matched for age (32 to 45 years). The fructose and acid phosphatase values in the vasectomised men, 3 to 6 months after the operation, were 316 +/- 36 mg% and 2,098 +/- 112 K.A. units/ml, respectively, while in the control group they were 251 +/- 28 mg% and 1,932 +/- 92 K.A. units/ml. The differences are statistically significant (P less than 0.001) and the possible implications of the post-vasectomy rise in these androgen dependent seminal constituents are discussed.

Acid Phosphatase

Autoantibodies to acrosomal antigens of spermatozoa in vasectomized mice.

A total of 102 mice from seven different inbred strains were vasectomized or sham vasectomized. Sera from these animals were collected before vasectomy and at 7 and 10 months after the operation. Indirect immunofluorescence on sperm smears showed that 26 per cent of vasectomized mice had antibodies to arosomal antigens of spermatozoa. This response was restricted to three of seven strains. None of the sera obtained from animals before vasectomy or from sham-vasectomized control mice contained similar antibodies.

Acrosome