Endocrinol Metab Clin North Am 1994 Dec;23(4):783-793
Male infertility.
Baker HW
Department of Obstetrics and Gynaecology, University of
Melbourne, Royal Women's Hospital, Australia.
Male infertility is a common problem but only about one quarter
of patients have specific or defined conditions that make them
either sterile or severely infertile. About half of these
patients have untreatable primary seminiferous tubule failure,
and donor insemination or adoption are the only possibilities of
having a family. The other half have potentially treatable
conditions, including genital tract obstruction, sperm
autoimmunity, gonadotropin deficiency, coital disorders, or
reversible toxin effects. The majority of men seen for
infertility (75%) have reduced semen quality, which impairs
fertility to a variable degree. Thus far no treatments have been
shown unequivocally to increase semen quality and fertility in
this group. Assisted reproductive technology has improved the
outlook for pregnancy in couples with male infertility and the
new technique of intracytoplasmic sperm injection promises to
further improve results for those with severe sperm defects or
previous failure of in vitro fertilization.
*****
Arch Androl 1997 Nov;39(3):197-210
Relationship between etiological factors and total motile sperm
count in 350 infertile patients.
Martin-Du Pan RC, Bischof P, Campana A, Morabia A
Department of Obstetrics and Gynecology, University of Geneva,
Switzerland.
The prevalence of different etiologic factors has been evaluated
in 350 male patients consulting the same physician in an urban,
ambulatory setting for primary or secondary infertility of more
than 1 year. Environmental factors such as alcohol or drugs
represented 12% of the etiologies, acquired diseases such as
varicocele and prostatitis 40%, congenital diseases and primary
testicular failure 16.2%, idiopathic cases 19.4%, and abnormality
of sperm transport 7.4%. The severity of sperm alterations in the
different etiologic categories was evaluated by the total motile
sperm count per ejaculate (TMS) (normal > 16). The TMS was less
than 5 in classical causes of male infertility such as testicular
failure, endocrinopathy, cancer, or antisperm antibodies. It was
more than 10 in controversial causes of infertility such as
varicocele, prostatitis, chlamydial infections, and professional
exposure to heat. After treatment, there was a nonsignificant
increase of the TMS in the latter cases. In cases of azoospermia
of pituitary origin, the TMS was normalized by a hormonal
treatment. In some cases of azoospermia of possible obstructive
origin, sperm appeared in the ejaculate after diclofenac
treatment. The utility of andrological investigation and
treatment is discussed.
The rough skin makes me think of hypothyroidism. I assume you
had that checked; its pretty routine for anovulation. The excess
hair growth can represent androgen excess from the ovary
(testosterone) or from the adrenal gland (DHEA). Have both of
those hormones been checked?
Also at your weight, a check for diabetes or abnormal glucose
tolerance should be done. Any abnormal glucose findings would go
along with PCOS. The weight itself is a problem for anovulation
as I'm sure you know. Weight watchers or Overeaters Anonymous may
be helpful for this at your weight. I don't mean to be unkind,
but I know its affect on health.
At this point, I would ask your RE (not quarrelously but
firmly) to do any additional studies such as the above. There is
a tendency on the part of many physicians to skip tests in the
interest of reducing costs if there is not going to be a
difference in the treatment. In your case, there may not be any
difference in how you are going to be treated unless the thyroid
test (TSH) or the adrenal test (DHEA) is abnormal. It may also be
that your RE is just judgmental about "large" women and may be
jumping to the conclusion that the weight is the only
problem.
Are you currently on any medication?
Have you had any treatment for the anovulation or are you just
in the diagnostic process now?
I read your reply, you asked if I am currently on meds. I am
not. My RE told me that Gonal F would be my next step, and as we
cannot afford this, and our insurance doesn't cover treatment,
this isn't an option. I was on 6 cycles of ClomidŽ last yr,
starting at 50 mg and ending at 150 mg. With HCG on day 14 of my
last cycle of ClomidŽ. I failed to ovulate on these (according to
BBT) I was not monitored. I had a glucose tolerance and the GYN
has written to the side of the numbers, "normal". This is why my
2nd GYN concluded that I didn't have PCO and referred me to an
RE. I have my records in front of me, and do not see the tests
for testosterone, DHEA or TSH anywhere, unless they are written
out in some other way. I had a thyroid test done in March of this
yr. The TSH from that test results say 4.26, this test was done
by a diet doctor, not my GYN or RE. If these are all important
tests, why weren't they done on me? Wouldn't a testosterone test
be a given? I don't want to sound argumentive but I would think
they would perform every test possible before I had to give up
with the Gonal F? None of my Dr's have mentioned my weight and I
have even asked them if it was affecting my fertility, they all
said no. Each said losing might help with labor and delivery, but
might not cure my infertility. The diet doctor said with my low
BBTs I wouldn't be able to get pregnant. I haven't heard any
other Dr mention this. They average 96.7 to 97.3 upon awakening.
Thank you very much for your help, and if you have any other
ideas, PLEASE reply. Do you think I should switch REs? He is dead
set on my beginning Gonal F. His reasoning for this was my FSH
was 4.1 and my E2 was 105.
I don't think you need to change REs, but just ask him to
check out the excess hair growth by looking at the ovarian and
adrenal androgens (testosterone and DHEA).
You probably will still need something like the Gonal F
(pituitary gonadotropin releasing hormone) because you failed to
ovulate with ClomidŽ. Moderate weight loss is well known to help
many women resume ovulation whether or not PCOS or adrenal
hyperplasia is a problem. The low basal body temperatures just
reflect the lack of ovulation. They don't CAUSE anything.
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