Harry Fisch

Declining Worldwide Sperm Counts: Disproving a Myth

This article explores in detail the issue of the alleged decline in semen quality. The impetus for a comprehensive re-evaluation at this time is threefold: (1) the potential impact of a real decline in semen quality and subsequent human fertility is a priori critical to human welfare; (2) governments have begun to enact anti-endocrine disruptor legislation that is based, in part, on selected portions of the published data about semen quality; and (3) confusion and misinformation about semen quality remain widespread in lay and professional circles.

Rising hypospadias rates: disproving a myth.

Hypospadias is one of the most common congenital abnormalities occurring in males. In recent years, the prevalence of hypospadias and whether that prevalence is rising or stable has become part of a larger debate over the potential effects of so-called endocrine disruptors, such as phthalates and bisphenol-A, on male reproductive health. This commentary critically examines allegations suggesting a worldwide increase in hypospadias rates. Despite the lack of scientific support for this hypothesis and for related claims that the disorders of male reproductive health are related to endocrine disruptors, these constructs remain firmly entrenched in popular literature, and are being used in part to justify litigation banning suspected endocrine disruptors such as phthalates and bisphenol-A. A review of the epidemiologic data on this issue amassed to date clearly demonstrates that the bulk of evidence refutes claims for an increase in hypospadias rates. This suggests that two of the three components of alleged testicular dysfunction syndrome, i.e. decline in sperm counts and rise in urogenital anomalies, lack clinical support. It further suggests that extrapolations from data derived in laboratory animal studies about alleged occult risks to humans of various candidate compounds are unwarranted at this time.

Infection and pyospermia in male infertility.

SummaryInfections of the male genitourinary tract may contribute to infertility by adversely affecting sperm function, causing anatomical obstruction or initiating a leukocyte response. The majority of infertile males are asymptomatic, and the significance and the criteria for the diagnosis of a genital tract infection are controversial. The evaluation for a genital tract infection focuses on urine and semen cultures as well as on the accurate quantitation of seminal leukocytes. An elevated seminal leukocyte count, pyospermia, can be associated with male infertility and may reflect an infectious or inflammatory disorder. In addition, the role of specific genital tract infections such as chlamydiosis, gonorrhea, ureaplasma and trichomoniasis and their possible association with male infertility is addressed.

Management of ejaculatory duct obstruction: etiology, diagnosis, and treatment

Abnormalities of the distal ejaculatory ducts related to infertility have been well-documented. Although there are no specific findings associated with ejaculatory duct obstruction, several clinical findings are highly suggestive. A diagnosis of ejaculatory duct obstruction is suggested in an infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex characteristics, testes, and hormonal profile, and dilated seminal vesicles, midline cyst, or calcifications on TRUS. Other causes of infertility may be concomitantly present and need to be evaluated and treated. Trans urethral resection of ejaculatory ducts (TURED) has resulted in marked improvement in semen parameters, and pregnancies have been achieved. Proper patient selection and surgical experience are necessary to obtain optimal results. In case of testicular dysfunction, chances of success are minimal. Extended follow-up periods are needed after TURED to examine the long-term effects of this procedure. Better understanding of the anatomy and pathology of the ejaculatory ducts will continue to refine diagnostic and therapeutic procedures for this disorder.

Transurethral resection of the ejaculatory ducts for treating ejaculatory symptoms

To report our experience with transurethral resection of the ejaculatory ducts (TURED) in infertile men with symptomatic ejaculatory duct obstruction (EDO).

Seminal Vesicle Urinary Reflux as a Complication of Transurethral Resection of Ejaculatory Ducts

Transurethral resection of ejaculatory ducts has become an effective surgical treatment for male infertility caused by ejaculatory duct obstruction. We report on a patient treated successfully by transurethral resection of the ejaculatory ducts for a large midline cyst who postoperatively complained of terminal urinary dribbling lasting several minutes. On video urodynamic study reflux into and delayed drainage from the right seminal vesicle were found.

Macleod Revisited: Sperm Count Distributions in 374 Fertile Men From 1971 to 1994

OBJECTIVESnThere has been an enormous amount of interest as to whether sperm counts are declining over time. We sought to compare a contemporary group of fertile men to those from the MacLeod study of 1951 to ascertain whether sperm counts in fertile men have changed over time.nnnMETHODSnWe obtained sperm count data from 374 fertile men who banked sperm in Minnesota prior to vasectomy from 1971 to 1994 and compared them to sperm count distributions from the 1000 fertile men of MacLeods study. Semen analyses were performed as per World Health Organization guidelines using identical techniques in both the present and MacLeod studies.nnnRESULTSnThe contemporary group had a mean sperm count of 102 +/- 81 x 10(6)/mL (median 85 x 10(6)/mL) compared to 107 +/- 74 x 10(6)/mL (median 90 x 10(6)/mL) for MacLeods data. There are no significant differences in mean or median sperm counts or sperm count distributions between the groups.nnnCONCLUSIONSnWe find remarkable similarities in sperm count distributions in cohorts of fertile men from 1951 and 1971 to 1994. Sperm counts in fertile men have not changed appreciably in the 40 years since MacLeods report.

The relationship of sperm counts to birth rates: a population based study.

PURPOSEnWe determined if a statistical relationship exists between changes in sperm counts and birth rates by comparing data from a single geographic location for a 24-year period.nnnMATERIALS AND METHODSnWe retrospectively analyzed data from 660 men who banked 1,972 semen samples before vasectomy in Minnesota from 1971 to 1994. Using general linear models, annual variations in sperm count were determined after adjusting for age, duration of abstinence and seasonal (monthly) effects. Adjusted annual mean sperm count was then correlated with regional birth rate data obtained from The National Center for Health Statistics.nnnRESULTSnMultiple regression analysis revealed a significant linear increase in mean annual sperm count at an estimated rate of 1.03 x 10(6) sperm per ml. per year (b = 0.14, t = 5.641, p < 0.0001). There was no effect of age (t = -0.814, p = 0.4156) but there were significant effects of abstinence (b = 0.14, t = 8.808, p < 0.0001) and month of sperm banking (b = 0.025, t = 5.00, p < 0.0001) on sperm counts. Using analysis of covariance there was a significant, nonlinear (year-to-year) fluctuation in mean sperm counts (F = 8.63, p < 0.001). For the study period mean birth rates in Minnesota (live births per 1,000 population) fluctuated yearly from 13.8 in 1973 to 16.7 in 1981. There was a strong correlation between adjusted mean yearly sperm count and annual birth rates (r = 0.63, p = 0.001).nnnCONCLUSIONSnWe found a statistically significant correlation between yearly variations in mean sperm counts and birth rates. Our data suggest that variations in male reproductive function may affect population based birth rates and, therefore, may be more important than previously understood.

Urologic aspects of andropause

Increasingly, physicians will seeelderly people in their everyday practice.Aging-related health problems, including thegradual decrease in gonadal function in men aftermiddle age (“andropause”), have gained interest inthe medical community. The term “andropause” isphysiologically incorrect, because, unlike women,men do not experience universal absolute gonadalfailure. Some investigators have therefore sug-gested more appropriate names, such as androgendecline in the aging male

The relationship of long term global temperature change and human fertility

UNLABELLEDnAccording to the United Nations, global fertility has declined in the last century as reflected by a decline in birth rates. The earths surface air temperature has increased considerably and is referred to as global warming. Since changes in temperature are well known to influence fertility we sought to determine if a statistical relationship exists between long-term changes in global air temperatures and birth rates. The most complete and reliable birth rate data in the 20th century was available in 19 industrialized countries. Using bivariate and multiple regression analysis, we compared yearly birth rates from these countries to global air temperatures from 1900 to 1994.A common pattern of change in birth rates was noted for the 19 industrialized countries studied. In general, birth rates declined markedly throughout the century except during the baby boom period of approximately 1940 to 1964. An inverse relationship was found between changes in global temperatures and birth rates in all 19 countries. Controlling for the linear yearly decline in birth rates over time, this relationship remained statistically significant for all the 19 countries in aggregate and in seven countries individually (p<0.05).nnnCONCLUSIONSnThe results of our analyses are consistent with the underlying premise that temperature change affects fertility and suggests that human fertility may have been influenced by change in environmental temperatures.