Rebecca Z. Sokol

Comparison of the kinetics of injectable testosterone in eugonadal and hypogonadal men

Serum reproductive hormone levels were measured serially after eugonadal and hypogonadal men had received either a 200-mg or a 100-mg intramuscular injection of testosterone enanthate. The calculated mean integrated testosterone and estradiol levels indicated that the 200-mg testosterone enanthate injection in the hypogonadal subjects maintained eugonadal levels of these hormones through day 11. The 100-mg dose maintained eugonadal levels of these hormones through day 11. The 100-mg dose maintained eugonadal testosterone levels through day 7. The testosterone:estradiol ratios in both groups following the 200-mg injection remained above or at the eugonadal baseline trough day 21. The authors recommend that replacement therapy for hypogonadal men should be 200 mg of testosterone enanthate every 10 to 14 days. A similar dosage would be recommended if testosterone enanthate were to be used as an experimental inhibitor of spermatogenesis (contraceptive agent).

Prenatal lead exposure in the rat during the third week of gestation: Long-term behavioral, physiological, and anatomical effects associated with reproduction

Sprague-Dawley dams were administered lead acetate (0.1%) in their drinking water from Day 14 of gestation to parturition to determine whether exposure of the fetus to elevated lead (Pb) levels during a period of rapid differentiation of the hypothalamic-pituitary-gonadal (HPG) axis would disrupt HPG function in adulthood. At birth, offspring from 20 Pb-treated and 10 control dams were weighed and 2 litter representatives from each sex were fostered to untreated dams. Animals were weaned at 26 days of age and subsequently group housed by sex and treatment. Blood Pb levels in prenatally exposed pups were below the limits of detectability at weaning. Female offspring from Pb-treated dams were found to have a significant delay in the day of vaginal opening. In a sample of lead exposed females, 50% were found to exhibit prolonged and irregular periods of diestrous which was accompanied by an absence of observable corpora lutea when they were euthanized at 83 days of age. Male offspring from these dams were found to have decreased sperm counts at 70 and 160 days of age and to exhibit significantly less territorial scent marking and masculine sex behavior in adulthood compared to controls. Azoospermia was observed in 1 lead exposed animal at 70 days of age and 2 animals at 160 days. Enlarged prostates were observed in Pb-exposed males measured at 160 days, but other sex organ weights were normal. Volume of the sexually dimorphic nucleus of the preoptic area of the hypothalamus in adulthood was significantly reduced by approximately 35% in Pb-exposed males. Pulsatile release of gonadotropins, measured in castrated adult animals of both sexes, revealed irregular release patterns of both FSH and LH in some Pb animals which were not observed in controls. The overall pattern of results suggests that multiple levels of the HPG axis can be affected by exposure to Pb during a period of gestation when structures related to the HPG axis are undergoing rapid proliferation. These data indicate that lead exposure during this period places the exposed animal at significant risk for reduced reproductive capacity in adulthood.

Immunohistochemical localization of relaxin in human prostate.

We identified relaxin in human male prostate by use of an anti-human relaxin analogue polyclonal antibody and the avidin-biotin-immunoperoxidase method. The antibody was obtained by immunizing a rabbit with a synthetic human relaxin analogue which has 95% sequence homology with native human relaxin. Human prostate tissues incubated with the anti-human relaxin analogue exhibited positive immunostaining up to an antibody dilution of 1:3200. Inhibition of immunostaining with this antibody by excess relaxin analogue demonstrated specificity of the antibody. The exact role of relaxin in human male reproductive physiology remains to be fully elucidated.

Infertility in the Male

: Male infertility is a common and distressing problem in which reproductive abnormalities frequently play an important role. Assessment requires an understanding of the control of spermatogenesis and factors responsible for normal sperm function. Standard tests for assessment of semen quality frequently fail to detect impaired function, but newer tests are now available to measure sperm movement and their ability to penetrate the ovum. Algorithmic approaches based on laboratory data can be used to characterize subgroups of infertile men, but many patients have subtle abnormalities. Treatment of male infertility is ideally directed to a specific pathogenic mechanism; nonspecific therapies have produced disappointing results. Surgery is indicated for certain types of ductal obstruction, but whether internal spermatic vein ligation should be used to treat varicocele remains uncertain.

Serum and Semen Zinc Levels in Normozoospermic and Oligozoospermic Men

Zinc is necessary for growth, sexual maturation and reproduction. Because high concentrations of zinc are found in the male reproductive system, a relationship between zinc and male infertility has been suggested. We studied 11 unselected men who presented to a Reproductive Endocrinology Clinic with histories of infertility and low sperm counts. Reproductive hormones and semen and serum zinc levels were measured. All men had semen analyses performed on at least three separate occasions. A similar set of laboratory evaluations were performed on 11 other men who had normal semen analyses and no history of infertility. No abnormalities of reproductive hormones were found in either group. Mean serum zinc levels were significantly lower in the infertile men (p less than 0.05). Mean semen zinc levels were not significantly different. There was no correlation between serum and semen zinc levels in either group. A significant correlation was found between sperm count and semen zinc (r = 0.66, p less than 0.05) in the volunteers with normal counts, but not in the oligozoospermic men. The results obtained in this study suggest that lowered serum zinc is more common than formerly appreciated in unselected patients with infertility. The high level of zinc found in semen is due primarily to the secretions of the prostate gland and reflects prostatic stores. Serum zinc is thought to be a reasonable indicator of zinc status. The lack of correlation between serum zinc and semen zinc found in our study suggests that mild zinc deficiency may lower serum zinc while the larger prostatic zinc stores remain unaffected.(ABSTRACT TRUNCATED AT 250 WORDS)

Demonstrated paternity in spite of severe idiopathic oligospermia

In this study we report on a successful pregnancy in the spouse of a man who, on repeated occasions, spaced over 3 years, presented with a mean sperm concentration of less than 200,000 sperm/ml. Serum was drawn from the father, mother, and daughter for polymorphic gene marker analysis. The calculation of relative probability of paternity with the use of gene frequencies for whites gave a figure of 99.9% that our patient is the father of the child.

Endocrine evaluation in the assessment of male reproductive hazards

Male reproductive function requires the integrated functioning of the hypothalamus, pituitary, and testis. The disturbance of endocrine function at any of these levels may result in hypogonadism and infertility. The clinical and laboratory evaluation of these disorders is reviewed here.

Combined hormonal contraception and the risk of venous thromboembolism: a guideline

While venous thromboembolism (VTE) is rare in young women of reproductive age, combined oral contraceptives increase the risk of VTE. In the patient in whom combined hormonal contraception is appropriate, it is reasonable to use any currently available preparation.

Transferring embryos with genetic anomalies detected in preimplantation testing: an Ethics Committee Opinion

Patient requests for transfer of embryos with genetic anomalies linked to serious health-affecting disorders detected in preimplantation testing are rare but do exist. This Opinion sets out the possible rationales for a providers decision to assist or decline to assist in such transfers. The Committee concludes in most clinical cases it is ethically permissible to assist or decline to assist in transferring such embryos. In circumstances in which a child is highly likely to be born with a life-threatening condition that causes severe and early debility with no possibility of reasonable function, provider transfer of such embryos is ethically problematic and highly discouraged.

Provision of fertility services for women at increased risk of complications during fertility treatment or pregnancy: an Ethics Committee opinion

This opinion addresses the ethics of providing fertility treatment to women at elevated risk from fertility treatment or pregnancy. Providers ethically may treat women at elevated risk provided that they are carefully assessed; that specialists in their medical condition are consulted as appropriate; and that patients are fully informed about risks, benefits, and alternatives, including oocyte and embryo donation, use of a gestational surrogate, not undergoing fertility care, and adoption. Providers also may conclude that the risks are too high for them to treat particular patients ethically; such determinations must be made in a medically objective and unbiased manner and patients must be fully informed of the decision. Counseling of women who wish to initiate fertility treatment with underlying medical conditions that confer increased risk during treatment or pregnancy should incorporate the most current knowledge available, being cognizant of the womans personal determinants in relation to her reproductive desires. In such a way, both physician and patient will optimize decision making in an ethically sound, patient-supportive context.