HORMONE LOAD TESTS I N INFERTILE MALE PATIENTS

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I. GERHARD, H. K. LENHARD, W. EGGERT-KRUSE, and B. RUNNEBAUM

The recognition that discreet hormonal abnormalities may cause ovulation disorders in women suggested that the male partner of infertile women might also suffer from unrecognized hormonal dysfunction amendable to substitution therapy. We obtained a combined stimulation test with gonadotropinreleasing hormone (GnRH), thyreotropin-releasing hormone (TRH), and ACTH in 225 males with childless spouses, when the couple sought to have children for at least one year. The following hormone levels were determined: estradiol (E), thyroid-stimulating hormone (TSH), prolactin, testosterone (T), dihydrotestosterone (DHT), androstenedione(A), 17-OH-pregnenolone (17-OH-Preg), 17-OHprogesterone (17-OHP), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), cortisone (F), and 21-desoxycortisone (21DF). Basal and stimulated, and adrenal-testicular steroids with and without ACTH stimulation failed to demonstrate a relevant relationship to semen parameters. Gonadotropin levels had a significant negative correlation to all important semen parameters (testicular volume, sperm count, motility, morphology, and vitality) and were positively correlated to spermiogenetic defects. Stimulated LH values were more clearly associated with spermiogenetic defects than basal LH. Nonetheless, basal FSH concentrations were more informative than LH. Stimulated prolactin values were positively correlated with both gonadotropin and with sperm morphology. E concentrations had a significant positive correlation with both basal and poststimulation DHEAS values, and showed a highly negative correlation with sperm count, morphology, and vitality. In comparison, good sperm parameters were associated with high poststimulation T concentrations. The results of this study suggest that basal FSH and E concentrations, as well as the stimulated LH, T, and prolactin determinations, should be included in the evaluation of male sterility. Key Words: Hormone; Diagnostic; Male infertility; Infertility.

INTRODUCTION Women with ovulation disorders often demonstrate discreet, subclinical hormone abnormalities. The ovulation disorders had an excellent prognosis when specific therapy was initiated [ 171. It thus appeared realistic to suspect that hormone examinations in men might identify endocrine disturbances similarly amenable to therapy. Andrologic abnormalities probably exist in 40% of all couples with the unrealized desire for children. The causes of male sterility remain unknown in 50-80% of all patients. Since

Received May 13, 1991. Accepted June 1, 1991. From the University of Heidelberg, Department of Gynecological Endocrinology, Heidelberg, Germany. Address correspondence to Prof. Dr. I. Gerhard, Department of Gynecological Endocrinology, Women’s Hospital, University of Heidelberg, VoB-Str. 9, 6900 Heidelberg, Germany. ARCHIVES OF ANDROLOGY 27:129-147 (1991) Copyright 0 1991 by Hemisphere Publishing Corporation

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male gonads are subordinate to complex regulatory mechanisms with numerous adapting circuits, their injury from exogenous or endogenous factors can cause secondary testicular dysfunction [25]. It was the goal of the present study to use hormone stimulation tests to assess pituitary, thyroid, adrenocortical, and testicular function and to identify relationships to various semen parameters.

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PATIENTS AND METHODS Hormone determinations were obtained during a half-year period from men whose wives consulted the Women’s Hospital Infertility Unit of the university. The mean age of the 225 males included in the study was 33 years (range 33-52 years). On average, couples had sought to have a baby for 5 years (range 1-25 years). Fifteen of the examined men had fathered children. The examination was the initial andrologic evaluation of 149 (70.5%) men. All other men had received 1-9 (mean = 1) andrologic therapies. Previous therapy for infertility was invariably completed at least one half-year before the present examination, The physical examination revealed a unilateral semicastration in two men, two others had inguinal testicles, three had a hydrocele, and one had an induratio penis plastica. Varicoceles were observed in 27 of the examined males. An indwelling canicula was introduced into the cubital vein of all men on the morning of the examination. Three blood samples drawn at 15-min intervals were pooled to smooth brief shifts in hormone levels. The hormone concentrations were determined from this pooled blood. Intravenous stimulation with 200 pg thyroid-inducing hormone (TRH), 0.25 mg ACTH, and 100 pg gonadotropin-releasing hormone (GnRH) was begun, immediately following the collection of each pooled blood sample. Additional serum probes were obtained 30, 60, and 120 min after the stimulation. The following hormone concentrations were determined: only the basal concentrations for follicle-stimulating hormone (FSH) and estradiol- 170 (E), basal concentrations and 30-min poststimulation values for thyroid-stimulating hormone (TSH) and prolactin; basal and the 30-, 60-, and 120-min poststimulation values for luteinizing hormone (LH); and 0-, 60-, and 120-min values for testosterone (T), dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulfate(DHEAS), 17-OHprogesterone (17-OHP), 17-OH-pregnenolone (17-OH-preg), androstenedione (A), cortisone (F), and 21-desoxycortisone (21DF). All men were referred for evaluation to the university’s Department of Andrology within 14 days of the hormone determination. Personal history was taken, after which the genitals were examined. Testicular volume was calculated, and ejaculate was collected during masturbation. A 5-day period of abstinence had preceded the examination. Immediately after liquefaction of the ejaculate the following parameters, classified in accordance with WHO guidelines, were determined: volume, pH, liquefying time, color, smell, sperm count, immediate motility and the motility after 2 and 4 h incubation at room temperature, morphology, vitality, fructose content and round cell number. Calculations were generally carried out with the patient’s original values. Additionally, the spermiograms of 118 patients were classified as pathologic or normal (normal: sperm count > 20 million/mL, propulsive motility > 40%, normal morphology and vitality > 60%). We observed the following pathologic spermiograms: azoospermia (n = 3), oligoasthenoteratozoospermia (n = 27), oligoasthenozoospermia (n = I),

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oligoteratozoospermia (n = 5), asthenoteratozoospermia (n = 43), oligozoospermia (n = 1), asthenozoospermia (n = 13), and teratozoospermia (n = 13). Radioimmunologic procedures were used for all hormone determinations (Table 1). The observed cross reactions between the numerous measured hormones were below 1%, excepting the following: T with DHT, 25 % ; A with T, 5 %, DHEA and DHEAS with A, 15% ; 17OHP with 17-OH-Preg, 53%, and with 21DF, 12%; 21DF with 17-OH-Preg, 13%, and with 17-OHP, 32 % . The results of the hormone determinations were classified with respect to the laboratory’s norm values as reduced, normal, or above the normal range. Since few hormone values were located outside the normal range, and since norm values for the stimulation tests were lacking, we also used percentiles to classify results. Concentrations were considered to be reduced when they were located below the 25th percentile, they were judged normal when situated between the 25th and the 75th percentile, and they were thought to be elevated when they occupied a place above the 75th percentile. Furthermore, for different points in time, the difference between the prestimulative and maximum poststimulative concentration was calculated for each hormone (delta hormone value). These values were ranked by placing them into three groups with respect to their percentile position. Hormone levels, andrologic data, and clinical findings were analyzed statistically at the university computer center. The univariate procedure was used to determine the normal distribution of the examined variables. Duncan’s test was used for mean value comparisons of normally distributed independent groups. The Kruskal-Wallis test was used when data failed to be normally distributed, or for groups containing fewer than 10 observations. The relationship between continuous variables was determined with Spearman’s rank correlation coefficient. The RSQARE procedure was used for regression analysis of continuous variables, while logistic regression (10) was used for discreet variables. The level of significance was placed at p = .01.

RESULTS Description of the Hormone Tests and Semen Parameters The population of examined men was highly heterogeneous and showed widely differing sperm counts, motility, and morphology. The sperm count varied from 0 to 378 million/mL. Zero to 80% of the spermatozoa of each sample had a normal motility, and 30-93% of the examined spermatozoa had a normal morphology (Table 2). The semen of all patients had a normal color, smell, and consistency. Normal values have not been reported for numerous hormones, whose concentrations were assessed during this study. We therefore tabulated the distribution of obtained values before and after stimulation (Table 3). Note the wide scatter of values. The highest LH values were registered 30 min after stimulation. Adrenal steroid concentrations at 2 h poststimulation were often slightly elevated when compared to the 60-min values. Only the DHEAS and DHT concentrations remained relatively stable during the 2-h period.

Correlations Among the Hormones Various hormonal relationships were examined in men due to dearth of knowledge about the interrelationships of different hormone systems to each other (Tables 4-6). The most interest-

FSHa

Unit

=FSH, Follicle-stimulating hormone. bLH, Luteinizing hormone. T S H , Thyroid-stimulating hormone

Prolactin TSH' Estradiol Testosterone Dihydrotestosterone Androstenedione DHEA-sulfate Dehydroepiandrosterone 17-OH-pregnenolone 17-OH-progesterone Cortisone 2 1-Desoxycortisone

LH~

Hormones

FSH MAIAclone Kit, Serono LH MAIAclone Kit, Serono DELFIA Prolaktin Kit, LKB Wallac Magic Lite TSH Kit, Ciba Coming Magnetic Estradiol Maia Kit, Biodata Own antibody Own antibody Own antibody Own antibody Own antibody Own antibody Own antibody Own antibody Own antibody

Method

< 2500 3500 pg/mL, n = 68) had significantly elevated LH serum concentratins (mean value 3.46 vs 2.88 mU/mL), high basal TSH (mean: 1.57 vs 1.24 pU/mL), and stimulated TSH measurements (mean: 10.42 vs 9.04 pU/mL). The basal 17-OHP demonstrated a significant correlation to all other steroids, including T, DHT, E, and LH. Stimulated 17-OHP concentrations were closely related to the poststimualated 17-OH-Preg, 21DF, A, and T concentrations. Only two patients had elevated 17-OHP levels ( > 250 pg/mL). Basal A values had a statistically significant correlation to the concen-

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trations of all basal adrenal-testicular steroids, most prominently with F and DHEA. No additional information was derived from the elevated poststimulated hormone levels, The basal and stimulated T concentrations were most closely associated with the DHT values for all sample periods. The correlation with A, as well as with the basal LH concentration, was considerably lower. Furthermore, a low correlation was observed between T and 17OHP, as well as to 21DF. When patients were classified according to their respective percentile position, we noted that those with reduced T concentrations differed in their mean A and DHT values, relative to the other patients. When the maximal poststimulated T values were analyzed (75th percentile: 64 550 pg/mL, 25th percentile 4060 pg/mL) we recognized a significant relationship between these T values and the three stimulated LH concentrations. The group with the most elevated T values had the most elevated mean LH values, which separated them from the other two groups. DHT and A results were comparable to the basal T values, but DHT and A had greater statistical significance for all time periods. DHT concentrations were most closely correlated with T, and slightly less with A, for all sample periods. When percentiles were compared, it became apparent that basal DHT values were also correlated with the 30- and 60-min stimulated LH concentration; specifically, the group with the most elevated DHT concentration had significantly different LH concentrations, relative to patients with normal or reduced DHT levels. Only three patients had E concentrations above the normal range of 60 pg/mL. The E values were most closely correlated with the DHEAS concentrations for all time periods. A less prominent relationship existed between E and basal 17-OHP as well as to the basal LH concentration.

Hormone and Semen Parameters Pituitary Hormones FSH values were significantly correlated to all important semen parameters (Table 7). A negative relationship existed between FSH and testicular volume, sperm count, motility, morphology, and vitality. Conversely, FSH was positively correlated to different spermiogenetic defects. These findings were substantiated when results were separated according to norm values and percentile groups. Comparable relationships as shown for FSH and the semen parameters existed between semen parameters and the basal and stimulated LH values (Table 8). In most instances, a higher correlation coefficient existed between the semen parameters and the stimulated LH concentrations than for the semen parameters and the basal LH. The use of delta-LH values demonstrated clearly that patients with relatively large delta values (>21.6 mU/mL) had spermatozoa with significantly compromised motility, morphology, and vitality. Basal TSH were lowest in men with fewest developmental defects at the sperm head (Table 9). Low basal TSH concentrations were also associated with a high proportion of propulsive motile spermatozoa. This relationship was not verified when stimulated TSH or the delta-TSH data were compared to these spermatic traits. In evaluating the relationship between prolactin and semen parameters we identified two significant associations: The stimulated prolactin value was positively correlated with sperm morphology (correlation coefficient, .1869; p < .01). Neither the grouping of prolactin values with respect to their percentile position nor the separation according to the delta-prolactin identified other significant relationships to semen parameters.

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Hormone Load Test

Adrenal-Testicular Hormones F,21DF, DHEA, DHEAS, 17-OH-Preg 17-OH-P, A. It was not possible to demonstrate significant correlations between these steroids and the semen parameters. When the level of significance @ < .01) was placed a t p < .05, we noted fewer round cells and more spermatogenic defects in semen samples of men with high F values 120 min after stimulation. Testicular volume was closely associated with 21DF, obtained 60 and 120 min after stimulation (60-min correlation coefficient .19088, p = .03; 120-min correlation coefficient .1872, p = .03). The separation of patients into standardized groups showed that those with higher 2 1DF values also had sperm with better motility @ = .02). A high delta-DHEAS was associated with the best immediate motility. Patients with the best sperm morphology had the lowest 17-OH-Preg values (p = .02). The group with the most elevated 17-OH-Preg concentration had the worst morphology characteristics. a significant inverse relationship was identified for semen volume and delta-17-OH-Preg concentrations, inasmuch as the group with the lowest delta- 17-OHPreg had the highest volume (p = .02). Furthermore, the group with the most elevated delta17-OH-Preg also had the most depressed sperm count @ = .03). A significant negative correlation existed between 17-OHP and morphological characteristics (correlation coefficent ,16, p = .02). Finally, 17-OHP was positively correlated with developmental defects of the sperm neck (correlation coefficient .20, p = .004). TESTOSTERONE (T) AND DIHYDROTESTOSTERONE (DHT). The basal T value was only related to sperm motility at 2 h, while stimulated T concentrations were positively correlated to all three motility parameters, as well as to morphology, vitality, and spermatogenetic defects (Table 10). The evaluation of maximal poststimulative T concentrations, as well as the separation into percentile groups showed that patients with the highest stimulated T values also had the best immediate and 2- and 6-h motility values. For example, the mean 2-h motility value for men with high maximal T concentrations was 41 % , TABLE 7 Relationship Between Different Sperm Parameters with FSH Assessed by Spearman’s Correlation Coefficient (SC) and by Calculating Level of Significance FSH

Sperm Parameters Testicular volume (mL) Sperm count (million/mL) Propulsive motility At 20 min (%) At 2 h (%) At 4 h (%) Morphology: normal forms (%) Vitality (%) Spermiogenetic defect Head (%) Neck (%) Tail (%)

Spearman’s Correlation Coefficient

Level of Significance

- ,542 1 - ,4172

,0001 ,0001

- ,3385

- ,3802

.0001 .0001 .oO01 ,0001 .oO01

,3720 ,2262 ,1605

,0001 ,0014 ,0235

- ,3659 - ,4088

- ,2923

@)

I. Gerhard et al.

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TABLE 8 Relationship of Sperm Parameters and LH Using Duncan’s Multiple Analysis (LH values were grouped according to the percentile) Sperm Characteristics

Testicular volume (mL)

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Sperm count (million/mL)

Propulsive motility At 20 min (%) At 2 h (%)

At 4 h (%)

Morphology Normal forms ( %)

Groupa

Mean

Symbolb

1

42 39 34 58 51 39 43 38 33 40 35 31 38 32 28 62 60 58 67 65 63 17 16 15 12

A A B A AB B

2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1

Vitality (%)

Spermiogenetic defect Head (%)

Neck (%)

2 3 3 2 1

3 2 1

11

I1

P 0.0043

0.0366

A

AB B A AB B A AB B A AB B A AB B A AB B A B B

0.0092

0.0225

0.0063

0.0066

0.0291

0.0168

0.0003

-

%3oup 1: LH < 25th percentile, < 2.0 mU/rnL (57 patients); Group 2: LH 25-75th percentile, 2.0-3.7 mU/mL (107 patients); Group 3: LH > 75th percentile > 3.7 mU/mL (61 patients). bGroups with different symbols show significant differences in their means.

while those with a low-maximal T concentration only had 28% motility (p = .0007). Similar relationships existed for morphology and vitality, even though the differences were less prominent (p = .0134 and p = ,0270). The differences were less visible when the delta-T value was calculated instead of using the maximal T concentration. Fewer relationships were described for DHT and the semen parameters than for T. A weak correlation was identified between basal DHT and the semen volume (p = .05). A slight relationship was seen between the stimulated DHT values and sperm motility (p = .05). ESTRADIOL (E). E had a significant negative correlation with sperm count, and the three parameters of motility, morphology, and vitality (Table 11). This means that good spermatic parameters were associated with low E-values. When E-values were grouped according to their percentile position, we noted only an association to sperm count (p = .0167); the group having the highest sperm count had the lowest estradiol values.

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HORMONE DEFECTS OF THE ADRENAL GLAND. The ACTH stimulation test identified a 2 1-hydroxylase deficiency in two patients (definition: basal 17-OH-P in excess of 2500 pg/mL, or stimulated 17-OHP exceeding 5500 pg/mL and a concurrent basal 21DF above 250 pg/mL or the stimulated 2 1DF exceeding 700 pg/mL). Both men had a 20% sperm motility rate, a normal sperm morphology under 60% (55 and 57%), a sperm vitality of 60%, and, respectively, 21 and 35 million sperm/mL. Thirty patients had a 30-OH-steroid dehydrogenase deficiency (definition: basal 17-OH-Preg value above 4000 pg/mL, or the stimulated 17-OH-Preg value above 14000 pg/mL, with a simultaneous basal DHEA value in excess of 8000 pg/mL, or the stimulated DHEA concentration exceeding 18000 pg/mL). When these patients were compared to others, we failed to observe significant differences in semen parameters. Sorting Spermiograms into Two and 9 Groups, Respectively Spermiograms were classified on the basis of sperm count, motility, and morphology, while the Kruskal-Wallis test was used for intergroup comparisons. Patients with azoospermia, oligoasthenozoospermia, and oligozoospermia were excluded from the evaluation due to their small numbers. Patients with oligoasthenoteratozoospermiahad the highest gonadotropin con-

TABLE 9 Correlation Between TSH Concentrations and Sperm Parameters Assessed by Multiple Analysis (Duncan) (Patients were placed into one of the three groups on the basis of their TSH concentration) Sperm Parameters

Propulsive motility At 20 min (%)

At 2 h (%)

At 4 h (%) Morphology Normal forms (%) Spermiogenetic defect Head (%)

Group'

Mean

Symbolb

1 3 2 1 3 2 1 3 2 1 3 2 2 3 1

41

A AB B A AB B A AB B A AB B A AB B

39 34 39 36 31 36 34 29 62 60 59 17 16 15

P ,0432

,0429

,0705

,0426

,0016

'Group 1: TSH basal 10.8 pU/mL and/or TSH at 30 min I 6.0 pU/mL. One or both TSH concentrations were below the 25th percentile (68 patients). Group 2: TSH basal = 0.9-1.6 pU/mL and TSH at 30 min = 6.1-12.2 pU/mL. Both TSH concentrations were between the 25th and 75th percentile (79 patients). Group 3: TSH basal 2 1.7 pU/mL and/or TSH at 30 min 2 12.3 pU/mL. One or both TSH concentrations were over the 75th percentile (78 patients). bGroups with different symbols show significant differences in their means.

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TABLE 10 Relationship Between Testosterone, Sperm Count, Propulsive Motility, Morphology, Vitality, and Spermiogenetic Defects Assessed by Spearman’s Correlation Coefficient (SC) and Level of Significance (p) for Each Parameter Testosterone

60 min

Basal

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Sperm Parameters Sperm count (million/mL) Propulsive motility At 20 min (%) At 2 h (%) At 4 h (%) Morphology: normal forms (%) Vitality (%) Fructose (pg/mL) Spermiogenetic defect: Head (%) Spermiogenetic defect: Neck (%)

sc

,1425

P

,0387

sc

120 min

P

sc

P

,1682

,0121

,1404

,0389

,1778 ,2282 ,1922

,0082 ,0009 .0056

,1453 ,1888 ,1614

,0332 ,0067 ,0221

,1795 ,1490

,0090 ,0321

,1479

.0334

,1358

,0478

- ,1700

.0166

,1813

,0084

TABLE 11 Relationship Between Estradiol, Sperm Count, Propulsive Motility, Sperm Morphology, Vitality, and Spermiogenetic Defects Assessed by Spearman’s Correlation Coefficient (SC) and by Calculating the Level of Significance (p) for Each Parameter Estradiol Sperm Parameters Sperm count (million/mL) Propulsive motility At 20 min (%) At 2 h (%) At 4 h (%) Morphology: normal forms ( % ) Vitality (%) Round cells/HPFa Spermiogenetic defect Head ( % ) Tail ( %) ‘HPF, high-power field.

sc

P

- ,1747

,008

- ,1745 -.I885 - ,1855 - ,1563 - ,1755 ,1394

.009 ,005 ,007 ,022 ,011 ,048

,2047 ,1544

,003 ,029

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TABLE 12 Predictors for the Spermiogram ~

Variables

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TSH (mU/mL) Prolactin (ng/mL) Gonadotropins (mU/mL) Estradiol (pg/mL) Testosterone (pg/mL) 2 I-Hydroxylase defect

3@-Hydroxysteroid-dehydrogenase defect

~~

Abnormal Basal < 0.4 or basal > 4 or stimulated < 4 or stimulated > 25 Basal 2 20 or stimulated L 60 FSH > 10 or LH basal > 8 or maximal stimulated LH > 50 L 40 Maximal stimulated < 4000 17-OH-progesterone basal > 2500 pg or stimulated > 5500 pg and 21-desoxycortison basal > 250 pg or stimulated > 700 Pg 17-OH-pregnenolone basal > 4000 pg or stimulated > 14000 pg and DHEA basal > 8000 pg or stimulated > 18000 pg

centrations and the highest E values (level of significance for FSH, p = .0001; for LH 0, 30, 60 and 120 min, p = .0061, ,0021, .0015, and .001, respectively, and for E, p = .0264). Men with isolated teratozoospermia had gonadotropin and E concentrations comparable to those of men with normal sperm characteristics, but differed from other groups in their basal F values, which were significantly lower @ = .0296). Logistic Regression A logistic regression was calculated for hormones suspected, on the basis of earlier analysis, of influencing the spermiogram (gonadotropin, TSH, prolactin, T, E Table 12). The gonadotropin concentration and the compromised T response to stimulation were selected, by the computer model, for evaluation (Table 13). The constant expresses that all other patients have a reduced probability for an abnormal spermiogram. Of the normal spermiograms 82% were correctly classified on the basis of the gonadotropin and stimulated T concentrations, but only 44% of the pathologic ones @ = ,001) (Table 14). This suggests that injurious nonhormonal influences must also be considered when evaluating patients with pathologic spermiograms.

DISCUSSION Hormone stimulation tests have not been evaluated for a sizable population of infertile men. Hormone stimulating tests were able to demonstrate subclinical thyroid function disturbances in 20% of all women with oocyte maturation disturbances [14], while adrenocortical enzymatic defects were recognized in 10-30% of these patients [13, 151. Specific therapy often allows conception in women with hormonal infertility [ 171. Therapeutic efforts are less successful in men with a pathologic spermiogram. A combined pituitary function test was therefore given to an unselected patient population. Few of the patients had pathologic basal hormone concentrations. Manifest hormone disturbances appear to be a rare cause for male infertility. For this reason both basal and stimulated hormone concentrations were grouped with respect to their percentile position as reduced, normal, or relatively elevated. The approach allowed groups to be occupied by relatively large populations, permitting statistical analysis. Only this approach permits associations to be identified between hormones and semen parameters. Due to the numerous statistical analysis used, and the risk of identifying false

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TABLE 13 Predictors That Increase the Risk of a Pathologic Spermiogram (sperm count < 20 million/mL, propulsive motility at 20 min < 40%, normal morphology < 60%) Predictors

Coefficient*

Elevated gonadotropins Abnormal testosterone

- 1.97 -0.86 2.38

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**

* and ** are necessary for the determination of the predicted probability of success for a normal spermiogram. Predicted probability of success

-1

3 . 3 8 - 1.97-0.86 +

2.38-1.97-0.66

relationships that lack real relevance, we placed the level of significance at .01. Indeed, we noted some interesting associations that were recognized only at a significance level of .05. Due to the large patient population and the expensive analysis, we did not consider these relationships. All basal and stimulated LH values had a highly significant correlation with all important sperm parameters. We found that stimulated LH values were more highly correlated than the basal ones, and that the relationship was negative. Nevertheless, FSH was more closely associated with semen parameters than the stimulated LH values. The particular place of the FSH concentration in the andrologic evaluation of fertility has been stressed by other authors [4, 12, 20, 24, 261, since FSH responds quickly to disturbances in gametogenesis. Primary disturbances in sperm development may result from reduced secretion of inhibin, causing FSH to rise, to reactivate sperm development [8, 301. A similar feedback mechanism can be considered to exist for LH since it, like FSH, was negatively correlated to the sperm parameters. Some authors failed to note a correlation between LH and inhibin [30], while others found a negative one [8]. Since FSH failed to correlate either with T or DHT, but was related to LH, it may be possible to explain shifts in the concentration of LH with the influence of T. The stimulated T concentrations were higher than the basal values. We were unable to differentiate TABLE 14 Classification of the Spermiogram According to Predictors Correct Classification Normal spermiogram' (n 118) Pathologic spermiogram' (n = 107) Total

-

Incorrect

n

%

n

%

97

82.2

21

17.8

44 141

41.1 62.1

63 84

48.9 37.3

'Sperm count 220 m i l l i o n h l ; propulsive motility at 20 min 2 4 0 % ; normal morphology 260%; 'Sperm count

Hormone load tests in infertile male patients.

The recognition that discreet hormonal abnormalities may cause ovulation disorders in women suggested that the male partner of infertile women might a...
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