Erkek infertilitesinin değerlendirilmesi

Abstract

EVALUATION of the MALE INFERTILITY SUMMARY It is estimated that 10-15 per cent of marriages are involuntarily childless; that is, there's the problem of infertility. The husband has been found to be the significant factor in about 40 per cent of these cases of infertility and to play an important contributing role in another 20 per cent; in the remaining 40 per cent, infertility is due to the female factors. In this study, we aimed to determine the biochemical parameters in the seminal plasma (fructose, glucose, LDH, cholesterol, acid phosphatase, zinc, magnesium and calcium), antisperm antibodies (ASA) in the semen and blood sera, and serum levels of some hormones which importantly contribute in fertility (FSH, LH, prolactin and testosterone) in the fertile and infertile (normozoospermic and azoo- oligozoospermic) men with a detailed semen analysis (characteristics of semen and spermatozoa) also; and then to compare the results in order to assess the importance of these parameters in evaluating the male infertility. All tests were performed in the fertile control group and two infertile groups, one of which included the normozoospermic and the other oligozoospermic infertile subjects. The physical characteristics of semen (color, volume, pH, viscosity and liquefication time) did not differ significantly between the fertile and infertile groups; however, four hiperviscous semen samples obtained from infertile subjects were found to liquefy in a longer than normal period. The mean values of sperm path velocity, per cent motility and per cent progressive motility evaluated directly after liquefication and 2 hours after collection of semen were found to be lower in both of the infertile groups, compared to the fertile group; all these differences were significant, except that of per cent progressive motility evaluated in the normozoospermic infertile subjects just after liquefication. Vitality was also found to be significantly lower in the infertile groups. The significant decrement (p< 0.001) in the fraction of sperms with rapid movement (V>25 a//sc), associated with the significant increment (p< 0.001) in the fraction of static sperms 90(V = 0) determined in both of the infertile groups, were found to be numerically more evident in the group with oligozoospermia. The fractions of morphologically abnormal sperms were determined to be significantly higher in both infertile groups, compared to the control group. Head anomaly frequency was highest in the infertile subjects and fertile controls; it was followed by tail and neck anomalies, respectively. The mean cholesterol, zinc and calcium levels in the seminal plasma were found to be significantly decreased in the normozoospermic infertile group., and that of glucose to be significantly increased in the azoospermic/oligozoospermic infertile group, compared to the fertile subjects. Increased seminal glucose in oligozoospermia was thought to be due to inadequate utilization of this substrate. Seminal fructose, LDH, acid phosphatase and magnesium levels did not differ significantly between the fertile and infertile groups. Antisperm antibody positivity couldn't be detected /n neither semen, nor sera of the fertile subjects. Six infertile subjects that showed ASA positivity in their semen and/or sera, were also astheno-and/or teratozoospermic. The mean levels of circulating hormones were found to be in normal ranges in both fertile and infertile groups, but significant differences were detected between them. FSH level in both of the infertile groups, and LH and testosterone levels in normozoospermic infertile group were found to be significantly decreased, whereas that of prolactin in azoo-and oligozoospermic infertiles to be significantly increased. When infertile subjects were evaluated individually for their circulating hormone levels; we led to the conclusions that infertility was not the result of hypogonadotrophism, none of the subjects definitely showed primary testicular insufficiency, and FSH deficiency and hyperprolactinemia incidences were higher in subjects with azoospermia/ oligozoospermia. 91

EVALUATION of the MALE INFERTILITY SUMMARY It is estimated that 10-15 per cent of marriages are involuntarily childless; that is, there's the problem of infertility. The husband has been found to be the significant factor in about 40 per cent of these cases of infertility and to play an important contributing role in another 20 per cent; in the remaining 40 per cent, infertility is due to the female factors. In this study, we aimed to determine the biochemical parameters in the seminal plasma (fructose, glucose, LDH, cholesterol, acid phosphatase, zinc, magnesium and calcium), antisperm antibodies (ASA) in the semen and blood sera, and serum levels of some hormones which importantly contribute in fertility (FSH, LH, prolactin and testosterone) in the fertile and infertile (normozoospermic and azoo- oligozoospermic) men with a detailed semen analysis (characteristics of semen and spermatozoa) also; and then to compare the results in order to assess the importance of these parameters in evaluating the male infertility. All tests were performed in the fertile control group and two infertile groups, one of which included the normozoospermic and the other oligozoospermic infertile subjects. The physical characteristics of semen (color, volume, pH, viscosity and liquefication time) did not differ significantly between the fertile and infertile groups; however, four hiperviscous semen samples obtained from infertile subjects were found to liquefy in a longer than normal period. The mean values of sperm path velocity, per cent motility and per cent progressive motility evaluated directly after liquefication and 2 hours after collection of semen were found to be lower in both of the infertile groups, compared to the fertile group; all these differences were significant, except that of per cent progressive motility evaluated in the normozoospermic infertile subjects just after liquefication. Vitality was also found to be significantly lower in the infertile groups. The significant decrement (p< 0.001) in the fraction of sperms with rapid movement (V>25 a//sc), associated with the significant increment (p< 0.001) in the fraction of static sperms 90(V = 0) determined in both of the infertile groups, were found to be numerically more evident in the group with oligozoospermia. The fractions of morphologically abnormal sperms were determined to be significantly higher in both infertile groups, compared to the control group. Head anomaly frequency was highest in the infertile subjects and fertile controls; it was followed by tail and neck anomalies, respectively. The mean cholesterol, zinc and calcium levels in the seminal plasma were found to be significantly decreased in the normozoospermic infertile group., and that of glucose to be significantly increased in the azoospermic/oligozoospermic infertile group, compared to the fertile subjects. Increased seminal glucose in oligozoospermia was thought to be due to inadequate utilization of this substrate. Seminal fructose, LDH, acid phosphatase and magnesium levels did not differ significantly between the fertile and infertile groups. Antisperm antibody positivity couldn't be detected /n neither semen, nor sera of the fertile subjects. Six infertile subjects that showed ASA positivity in their semen and/or sera, were also astheno-and/or teratozoospermic. The mean levels of circulating hormones were found to be in normal ranges in both fertile and infertile groups, but significant differences were detected between them. FSH level in both of the infertile groups, and LH and testosterone levels in normozoospermic infertile group were found to be significantly decreased, whereas that of prolactin in azoo-and oligozoospermic infertiles to be significantly increased. When infertile subjects were evaluated individually for their circulating hormone levels; we led to the conclusions that infertility was not the result of hypogonadotrophism, none of the subjects definitely showed primary testicular insufficiency, and FSH deficiency and hyperprolactinemia incidences were higher in subjects with azoospermia/ oligozoospermia. 91