Frank Comhaire

Hormonal effects of an antiestrogen, tamoxifen, in normal and oligospermic men.

The administration of tamoxifen, 20 mg/day for 10 days, to normal males produced a moderate increase in luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, and estradiol levels, comparable to the effect of 150 mg of clomiphene citrate (Clomid). However, whereas Clomid produced a decrease in the LH response to LH-releasing hormone (LHRH), no such effect was seen after the administration of tamoxifen. In fact, prolonged treatment (6 weeks) with tamoxifen significantly increased the LH response to LHRL. Treatment of patients with idiopathic oligospermia for 6 to 9 months resulted in a significant increase in gonadotropin, testosterone, and estradiol levels. A significant increase in sperm density was observed only in subjects with oligospermia below 20 X 10(6)/ml and normal basal FSH levels. When basal FSH levels were increased or oligospermia was moderate (greater than 20 X 10(6)/ml); no effect on sperm density was seen. As sperm density increased, FSH levels decreased, suggesting an inhibin effect. Sperm motility was not improved by tamoxifen treatment. In five boys with delayed puberty, tamoxifen treatment appeared to activate the pituitary-gonadal axis and pubertal development.

Selective Retrograde Venography of the Internal Spermatic Vein: A Conclusive Approach to the Diagnosis of Varicocele

Selektive retrograde Venographie der Vena spermatica interna: Ein überzeugendes Vorgehen zur Sicherung der Diagnose einer Varikocele

The clinical and biologic significance of serum inhibins in subfertile men

Inhibin B is a marker of spermatogenesis and Sertoli cell function. The objective of this study was to evaluate the biologic significance of inhibins in subfertile men and the usefulness of inhibin B for the detection of male reproductive dysfunction. Forty-seven subfertile men were evaluated by semen analysis and clinical examination. In addition to semen analysis and hormone determinations, inhibins A and B (Serotec) in all 47 and inhibin A in 25 of these samples using another kit (Biosource) were measured. Higher inhibin B (median, range: 160.3, 81.8-328.5 pg/mL vs. 94.9, 15.6-389.7 pg/mL, P = 0.024) and lower FSH (P = 0.001) were detected in men with sperm concentrations > or =20 million/mL (n = 9), compared to oligozoospermia (sperm concentration <20 million/mL, n = 38). Inhibin B correlated significantly negatively with FSH, LH, and E2, and patients age and positively with sperm concentration, testicular volume, and TSH. Multiple regression analysis indicated FSH, LH, E2, TSH, and age as the independent variables for inhibin B with a coefficient of determination (R) of 0.53. Simultaneous measurement of both FSH and inhibin B identified more cases with oligozoospermia than either hormone alone. Taking into account the body mass index, the age of the patient, and the indirect mixed antiglobin reaction (MAR) test result in addition to FSH and inhibin B led to the correct semen classification in 45 out of 47 cases. The simultaneous measurement of FSH and inhibin B, taking into account age, body mass index, and the indirect MAR test result appears accurate in identifying subfertility. Inhibin A is detectable in some subfertile men but its significance is not clear.

Factors affecting the probability of conception after treatment of subfertile men with varicocele by transcatheter embolization with Bucrylate.

Retrospective analysis of 100 patients treated for varicocele-associated infertility by means of transcatheter embolization with 2-isobutyl-cyano acrylate (Bucrylate, Ethicon Inc., Somerville, NJ) reveals that the age of the man and the duration of infertility do not influence the probability of pregnancy after treatment. Patients treated for subclinical varicoceles had the same probability of success as patients with larger varicoceles. The following factors were found to have predictive power as far as the posttreatment success rate is concerned: the coincidence of other disease interfering with the fertility of the man or woman, serum follicle-stimulating hormone concentration, total testicular volume, and pretreatment semen quality. Depending on the latter factors, the probability of conception varies between 8% and 80%. It seems possible to define certain subgroups of varicocele patients with poor, moderate, or good fertility prognosis.

Assessment of sperm function in fertile and infertile men

Summary. The sperm function of fertile men (control), infertility patients (experimental), and men with varicocele were compared. The bioassays used were the follicular fluid‐induced acrosome reaction, the binding to the zona pellucida, and the penetration of zona‐free hamster oocytes. The percentage (mean ± SEM) of reacted spermatozoa was 35 ± 3 in the control, 22±1 in the experimental, and 22 ± 3 in the varicocele. The minimum value of acrosome reaction in control men was 20%. The mean number of zona‐bound spermatozoa was 250 ± 30 in the control, 160 ± 28 in the experimental, and 196 ± 44 in the varicocele. The minimum number of zona bound spermatozoa in control men was 50. The mean number of hamster oocytes penetrated was 50 ± 8 in the control, 19 ± 3% in the experimental, and 10 ± 3 in the varicocele. The minimum number of oocytes penetrated in control men was 6%. In the experimental group, 22 men had a normal sperm function, 58 had 1 or 2 bioassays below the minimum (relative dysfunction), and 10 had all bioassay below the minimum (abnormal sperm function). The results of these bioassays could help to reclassify the infertile men in several subgroups.

Clinical and biological aspects of male immune infertility: a case‐controlled study of 86 cases

Summary. A case‐control study of clinical, endocrine and seminal characteristics in 86 infertile men and a prospective study of conception rates during 804 follow‐up cycles among 75 infertile couples with male immune infertility were performed. Genito‐urethral infections or surgery, and palpable epididymal abnormalities were more common among the immunological cases than among the non‐immunological infertile controls (n = 180), but sperm concentration, motility and morphology were similar. The spontaneous conception rate in 70 cases was 1.7% per cycle. Treatment by intra‐uterine insemination (IUI) resulted in 8.6% pregnancies per cycle, conventional in vitro fertilization (IVF) had a 18.4% success rate per attempt, and two out of three couples treated by intracytoplasmic sperm injection (ICSI) attained pregnancy. Minimal sperm quality required for successful IUI was not lower than that recorded in couples with spontaneous conception.

Quantifying the effectiveness and cost-efficiency of food supplementation with antioxidants for male infertility

In male infertility, complementary treatment with antioxidant-containing food supplements quadruples the spontaneous pregnancy rate and reduces the cost per pregnancy by 60%.

Conception rates and assisted reproduction in subfertility due to unilateral cryptorchidism.

Summary. During 774 spontaneous cycles and 87 cycles of assisted reproduction, the conception rates were evaluated in 48 infertile couples in whom unilateral cryptorchidism was the causal factor. In spite of adjuvant therapy of the male partner, the spontaneous conception rate was very low (1% per cycle). Intra‐uterine insemination (IUI) and conventional in vitro fertilization (IVF) resulted in similar success rates of 6.1 and 8.7% per cycle/attempt respectively. After intra—cyto‐plasmic sperm injection (ICSI), 46.7% pregnancies were obtained per attempt, and sperm requirements for the latter treatment to be successful were lower than for IUI. It is concluded that subfertility in men with unilateral cryptorchidism is severe, conventional IVF has little advantage, but ICSI is highly successful.

Beneficial effect of food supplementation with the nutriceutical Improve® for the treatment of infertile couple

Abstract Objective To assess the possible benefit of food supplementation with the nutriceutical Improve® for the treatment of the infertile couple. Methods The treatment of diseases causing male or female infertility should be completed by the prescription of a judiciously formulated composite nutriceutical (Improve® Nutriphyt Inc, Oostkamp, Belgium) which counteracts the pathogenic mechanisms involved in sperm and oocyte dysfunction, enhances cellular energy production, corrects oxidation-induced damage to the cell membrane and to DNA, and repairs mitochondrial insufficiency. The efficiency of this nutraceutical was tested in controlled trials and in assisted reproduction, including 1 888 infertile couples. Results Complementary food supplementation with the nutriceutical Improve® plus linseed oil improved the quantity and functional quality of spermatozoa, significantly increasing their fertilizing potential. This supplement with added fish oil enhanced female fertility with higher probablity of natural conception and ongoing pregnancy using techniques of assisted reproduction. Conclusions Complementary food supplementation with the nutriceutical Improve® has significant beneficial effects for the treatment of the infertile couple and reduces the cost per delivery.

The Benefit of Nutraceutical Food Supplementation and Antioxidants for the Treatment of the Infertile Couple and in Assisted Reproduction

Varicocele, male accessory gland infection, immunological infertility, and idiopathic oligozoospermia are the main causes of male infertility. Disturbances of ovulation, pelvic inflammatory disease, and endometriosis are common causes of female reproductive failure. The mechanisms by which these causes interfere with male and female reproduction are inflammation through prostaglandins and cytokines, and oxidative overload damaging the cell membrane, inducing mutagenesis of the DNA, and impairing mitochondrial energy production. A unique nutraceutical food supplement (NFS) has been created that aims at correcting these mechanisms and at reducing the influence of detrimental environmental factors. The efficiency of adding this NFS to causal therapy, or in assisted reproduction is expressed as numbers of couples needed to treat (NNT) to obtain one additional pregnancy. When the NFS is added to the treatment of varicocele the NNT is 3. Treating both partners with the NFS resulted in one additional ongoing pregnancy for every 4 IVF treatments.