Aquiles J. Sobrero

The Semen of Fertile Men. II. Semen Characteristics of 100 Fertile Men

From a population of men applying for voluntary sterilization, 100 consecutive cases were selected according to the following criteria: (1) each man had fathered at least two children; (2) at the time of the request for a vasectomy the mans wife was pregnant; and (3) a complete prevasectomy semen analysis, including sperm morphology, was available. The usual parameters of human semen evaluation are reported: the mean volume of the ejaculates was 3.3 ml +/- 0.84 SD (range, 0.5 to 11 ml); the mean sperm density was 81 million/ml +/- 57 SD (range, 4 to 318); while the geometric mean, which according to the sample distribution is more representative, was 68. The mean percentage of motile sperm was 63% +/- 16 SD (range, 10 to 95%); the grade of forward progression was 3 +/- 0.55 SD (range, 2 to 4); and for sperm morphology the mean number of sperm with oval heads was 75% +/- 6 SD (range, 21 to 90%). Statistical comparison of these findings with those of our previous study of the semen of 1300 fertile men revealed complete agreement; minor statistical differences, on single parameters, with three similar studies are indicated. A positive relationship between the different variables, sperm density and sperm motility (in percentage of motile sperm and degree of forward motion), as well as between the two variables of sperm motility and sperm morphology to the other variables was confirmed.

Sperm-agglutinating antibodies in 236 infertile couples.

19 wives of 236 couples had positive sperm agglutination tests. (SPAT) 6 of the 19 belonged to the 70 couples (9.4%) with no no known cause for infertility; 11 belonged to the group of 154 couples (7.1%) with a known cause; and 2 to the 12 couples inadequately investigated (15.7%). 6 of these 19 women (31.6%) became pregnant without condon therapy; of these 6, 3 had no known cause for infertility and 3 had a known cause. 11 husbands had positive sperm aggluatination tests. 4 of these 11 were among the 70 couples (5.6%) with no known cause for infertility, while the other 7 were among the 154 couples (4.5%) with a known cause. 5 of their wives (45.5%) became pregnant without any treatment. Outcomes of 8 of 11 pregnancies were normal deliveries and no abortioons, which showed that positive SPAT had no apparent effect on the pregnancies. There was no relationship between postitive SPAT and history of venereal disease, allergy, autoimmune disease, abortioon, postcoital tests, or ABO imcompatability.

Cervical Mucus Amylase Levels in Normal Menstrual Cycles

A clinical study was undertaken to assess the levels of cervical mucus amylase in women during normal menstrual cycles. Multiple cervical mucus samples were taken throughout the menstrual cycle in 15 ovulatory women and random samples taken in an additional 7 ovulatory women; all these women and their husbands had undergone evaluations for infertility etiology. The level of cervical mucus amylase was found to decrease during the ovulatory cycles at the time when the thermal shift in BBT (basal body temperature) cornification peak in vaginal cytology and the highest mucus scores also occurred. A secondary drop in the amylase level was observed in some cases coincidental with the midluteal estrogen surge. The results of the study indicate that mucus amylase levels are inversely related to estrogen output rather than to water content of the mucus. The presence of amylase does not seem to be related to infertility etiology.

Hysterography Study of Long-Term Effects of Intrauterine Contraceptive Devices*

254 women (ages 18-51) received hysterography from 24 to 72 months after insertion of IUDs (mostly Lippes loop). There were 37 percent asymptomatic cases 98 percent with uterine cavity changes and 70 percent with loop tip embedded in the uterus (not related to symptoms). In 87 percent of the cases tubal patency was demonstrated. 80 percent of the patients experienced side effects when the IUD was distorted or disoriented.(AUTHORS MODIFIED)

The comparative effects of estrogens on amylase levels of cervical mucus.

The influence of equine conjugated estrogens estriol and the 3-cyclopentyl ether of ethinyl estradiol (EECPE) on cervical mucus amylase secretion was studied both in patients with normal ovarian function and with premature ovarian failure. Conjugated estrogens produced an essentially normal pattern of cervical mucous amylase levels. No biologic estrogenic effects could be detected in either type of patient under the influence of oral estriol at the dosages used. EECPE when given to patients with normal ovarian function produced a fluctuating amylase pattern during the proliferative phase when ovulation was delayed or suppressed. Cervical mucous amylase levels were low and no fluctuations occurred in patients with ovarian failure treated with this long-acting estrogen. Under the influence of endogenous estrogen production stimulated with human menopausal gonadotropin (HMG) the amylase secretion levels were low. After HMG- human chorionic gonadotropin (HCG)-induced ovulations a directly proportional quantitative relationship between cervical mucous amylase and urinary pregnanediol levels was found.

Evaluation of a New Contraceptive

A series of tests were performed to measure the spermicidal efficacy harmlessness and acceptability of Emko Vaginal Foam. The manufacturer describes the foam as an oil-in-water dispersion which is combined under pressure with a liquefied gas propellant so that the liquid dispersion can be expelled as a foam into a vaginal applicator. Laboratory tests were made first. Then clinical tests were made to assess the acceptability of the foam. These consisted of single-dose tests in 8 women and 21-day tests during which 12 women used a daily dose for 21 days. None showed any subjective or objective evidence of local discomfort or irritation. 32 postcoital test were performed after use of the foam in 22 selected couples of reproductive age all of whom had had previous excellent postcoital test results and good semen analyses. Except in 5 cases when the time interval was 8-11 hours the postcoital test were made within 4 1/2 hours after coitus. In 29 tests no motile spermatozoa were found in either vaginal or endocervical specimens. In 3 tests 1-3 sperm feebly motile and without forward motion were seen in the endocervical mucus after a search of more than 40 dry high-power fields. The foam appears to possess a high degree of spermicidal activity in vivo.(AUTHORS MODIFIED)

THE SEMEN OF FERTILE MEN: STATISTICAL ANALYSIS OF 1300 MEN

The prevasectomy semen analyses of 1300 men who had fathered at least two children were studied. The ages of the men ranged from 23 to 64 years, with a mean age of 39.6 years; 84% of the men were Caucasian, 5% were black, and 5% were of other ethnic groups; 32% of the men were Roman Catholic, 26% Jewish, 22% Protestant, and 11% professed no religion; in 9% religion was not recorded. The number of children ranged from 2 (48%) and 3 (30.6%) to 10 (0.1%). The volume of the ejaculate ranged from 0.1 to 11.0 ml, with a mean of 3.2 ml plus or minus 1.4 SD. Sperm density ranged from 1.5 to 375 million/ml, with an arithmetic mean of 79 million/ml plus or minus 57 SD; however, the logarithmic or geometric mean was chosen as being more representative of the asymmetric distribution under study. The geometric mean was 65 million/ml, with standard deviation limits of 30 to 142 million/ml, figures that correspond to the 16th and 84th percentiles. The percentage of motile sperm ranged from 5 to 95%, with a mean of 65% plus or minus 22 SD. The grade of sperm motility, according to MacLeod and Golds classification (Fertil Steril 2:187, 1951) of 0 to 4, ranged from 1 to 4, with a mean grade of 3. There were 25 men (2%) with a sperm count below 10 million/ml and 26 (2%) in whom the percentage of motile sperm was less than 20%. Polyzoospermy (count greater than 250 million/ml) was found in 15 men (1.2%); one or more spontaneous abortions had occurred in six of the spouses of these men (40%), whereas the over-all spontaneous abortion rate was 7% and the spontaneous abortion rate for wives of men with sperm counts below 10 million/ml was 4%. A positive relationship was found between sperm density and percentage of motile sperm; the relationship between motility and the logarithm of sperm density was represented by a straight line (a 10-fold increase in sperm count was accompanied by an increase of 20.4% in sperm motility); the slope of the line was highly significant, although the correlation coefficient was weak (0.27). A similarly positive relationship was found between sperm density and grade of motility; however, the correlation coefficient was also weak (0.22). The relationship between the grade of motility and the proportion of motile sperm also positive, was reasonably large (0.70), although its significance is questionable because of the crudeness of the scale utilized to assess the grade of sperm motility. A comparison of the findings with those of similar studies was made.