Ruth Z. Gold

The Male Factor in Fertility and Infertility. II. Spermatozoön Counts in 1000 Men of Known Fertility and in 1000 Cases of Infertile Marriage

Spermatozoon counts in 1000 men of known fertility and in 1000 cases of infertile marriage were studied to determine the lowest semen standar ds compatible with relative ease of conception. The mean volume of ejaculate for fertile men was 3.4 cc and 3.7 cc for infertile men. 5% of fertile men had sperm counts under 20 million/cc while 16% of the infertile fell into this catagory. Peak for the infertile group was less than 20 million/cc while the modal count class for the fertile group was 60-80 million/cc. 50% of the infertile men had counts of 74 million/cc or less while half of the fertile men had counts over 90 million. In studying the infertile group 8% of the group with a previous conception had sperm counts under 20 million/cc while 19% of the nonconception group had this count. At the 95% level of confidence the minimum standard for fertility based only on sperm counts was 20 million/cc. In the 1000 fertile specimens the relationship between ejaculate volume and sperm counts was insignificant. There was a highly significant relationship between volume and count in the infertile group. The essential difference between fertile and infertile lies at a low sperm count level. However above this level fertility and sperm count increase inconsistently.

The kinetics of human spermatogenesis as revealed by changes in the ejaculate.

Theoretically, the spermatozoon content of the ejaculate in the normal human male represents the output of morphologically mature cells from the germinal epithelium. However, we have only fragmentary knowledge of the influences brought to bear on the spermatozoa in their transport through the duct system, particularly, in their passage through the epididymis. Until we have a more precise awareness of the quantitative relationships existing between the activity of the germinal epithelium and the number and quality of the spermatozoa delivered to the ejaculate, we cannot be assured that the total number of spermatozoa delivered to the ejaculate is an adequate measure of the activity of the germinal epithelium. For example, we must consider the possibility that some spermatozoa may not survive the environment of the epididymis and that abnormal conditions in that environment may, in some individuals a t least, result in undue germ-cell destruction, to the point where the number of cells appearing in the ejaculate is not representative of the functional state of the germinal epithelium as determined by the biopsy. Furthermore, we hear little of the method or rate of delivery of the spermatozoa to the more distal portion of the male duct system, the ductus deferens. Is the rate of progression of the sperm through the epididymis to the ductus deferens steady and unrelated to the “demand” for spermatozoa, or is the progression conditioned simply by the pressure from behind of spermatozoa produced a t a steady rate from the germinal epithelium? Lastly, how are the spermatozoa to be delivered in any given ejaculate brought to the ampulla of the ductus deferens where they are massed just prior to ejaculation? There is good evidence that the latter is true1 and we have some information on the time necessary for a similar number of cells to be massed a t that point. MacLeod and Heim2 demonstrated, in three ejaculates obtained a t 24 hour intervals, that there is a progressive fall in the total number of cells but that, in individuals whose sperm counts were high to begin with, the total number of cells in the third successive ejaculate need not represent a serious fall in the potential fertility of that individual. Farris,” in a similar study, submits essentially the same quantitative data so far as sperm counts are concerned, although it may be difficult to agree with him on the changes in potential fertility of the individuals concerned. In this presentation, we shall consider (1) the quantitative aspects of delivery of spermatozoa to the ejaculate in “normal” and oligospermic men after various periods of continence, ( 2 ) the rate of disappearance of spermatozoa from the ejaculate as a result of inhibition of spermatozoa maturation in the germinal epithelium and (3) the quantitative and qualitative aspects of the re-appearance