Evaluation of semen and pituitary gonadotropin function in men with untreated Hodgkin's disease.

The reproductive capacities of 35 patients with Hodgkin's disease were assessed before treatment by semen evaluation and determination of basal hypothalamic-hypophyseal function and after stimulation with gonadotropin-releasing hormone (GnRH). Sixty-five percent of the patients had asthenozoospermia, 46% had teratozoospermia, and 28% had oligozoospermia. Normal semen was more frequently seen in asymptomatic patients (7 of 18) than in symptomatic patients (2 of 15). All the patients had normal basal follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels and significantly low testosterone (T) levels (P less than 0.01). The FSH response to 100 micrograms of GnRH was normal, but the LH responses were all significantly low, both as delta % (28.4% +/- 18.7% versus 52.4% +/- 25.3%, P less than 0.005) and as peak values (36.7 +/- 20.7 mIU/ml versus 59.4 +/- 26.4 mIU/ml, P less than 0.01). It is believed that abnormal semen is a specific symptom of Hodgkin's disease, secondary to functional insufficiency of the hypothalamic-hypophyseal axis, with a relative decrease in T production.

Gonadal function in male heroin and methadone addicts.

Gonadal function was elevated in 80 male heroin and/or methadone addicts by measuring basal plasma levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL) and testosterone. In 41 subjects semen analyses were also undertaken. Three groups were distinguished consisting of 15 heroin addicts, 42 undergoing methadone treatment but continuing to take heroin, and 23 taking only methadone. All patients had normal plasma levels of FSH, LH and testosterone. Prolactin levels were normal in all subjects except for the 15 heroin addicts, in whom they were significantly higher than in controls (P less than 0.025). Semen analyses from all of the heroin addicts and from the dual heroin-methadone users were abnormal, whereas only 10 out of 22 (45%) of the methadone takers were pathological. In all cases asthenospermia was one of the abnormalities (100%). Twenty-four per cent also showed teratospermia and hypospermia and 17% showed oligozoospermia. Such seminal pathology, especially of forward motility, even in combination with normal hormone levels, might be an early indication of heroin toxicity to the male reproductive tract.

Changes in cervical mucus after diathermocoagulation of the cervix.

We have studied the principal chemophysical properties of cervical mucus obtained before and after diathermocoagulation (DTC) in 35 patients participating in a program for prevention of cervical carcinoma. Two months after DTC there were significant decreases in the cervical scores for both exo- and endo-cervical mucus (Moghissi scale). Twelve patients with favorable pre-DTC scores, whose condition had deteriorated 2 months subsequent to treatment, again displayed normal scores in both sites 1 year after DTC. We feel, therefore, that DTC does not cause any permanent change in the chemophysical properties of the cervical mucus, but instead only temporary deterioration during the repair phase.

Measurement of pH in the lower female genital tract during the periovulatory period: comparison of electrometric and colorimetric procedures.

In 53 patients with regular ovulatory cycles, the pH in the lateral vaginal fornix, at the external uterine orifice and in the cervical canal was measured daily in the periovulatory period. The values of pH measured by the colorimetric and the electrometric methods did not show any statistically significant difference. The relationship between pH values of cervical mucus and the estradiol peak is discussed.

Hysteroscopy versus hysterosalpingography in infertile patients.

The purpose of this study is to compare the results of Hysterosalpingography (HSG) and those of Hysteroscopy (H) in order to evaluate intrauterine morphology in a sample of 47 infertile patients. In the HSG sample having no intrauterine pathology, H showed up a pathological condition in 30% of the cases. Similarly, in the cases in which HSG showed pathologies, H gave normal results in 33.3%. Considering H to be a simple diagnostic method, which causes little trauma to the patient, and is more precise than HSG, the authors recommend the hysteroscopic approach, especially in cases of sterility of unknown origin.

Morphological selection of human spermatozoa in cervical mucus "in vivo".

Spermatozoa morphology at two levels in the cervical canal was compared, at the external and internal uterine orifices, in samples taken "in vivo" during 21 postcoital tests (P.C.T.s). P.C.T.s with cervical mucus, with Moghissi scores lower than 10 and exo- and endocervical pH less than 7 were excluded. At the upper level of the cervical canal, 12 of the 21 P.C.T. showed more than 5% more normal spermatozoa than at the lower level of the canal (in 5 of these P.C.T. the increase was greater than 10%). Selection for normal heads was seen in 2 and for normal tails in 4. The P.C.T. that selected for normal tails all had greater than 10% abnormal tails at the external orifice. These results confirm that there is some selection of spermatozoa during passage through the cervical canal. Above all, the selection appears to exclude those spermatozoa with defective locomotive mechanisms (abnormal tails), which indicates that the mucus acts as a "passive filter" with selection depending on the spermatozoa themselves in relation to motility.

Gonadal toxicity after combination chemotherapy for Hodgkin's disease. Comparative results of MOPP vs ABVD.

The comparative gonadal toxicity following two equally effective and non-cross-resistant regimens (MOPP and ABVD) was prospectively evaluated in 53 males with Hodgkin's disease. The median age was 29 yr (range 16-45). MOPP produced azoospermia in 28/29 patients (97%) while ABVD induced oligoazoospermia in 13/24 patients (54%). Follicle-stimulating hormone levels were consistently and significantly increased after MOPP while their median value remained within normal range after ABVD. Sperm count was repeated in 34 patients. Recovery of spermatogenesis occurred in 3/21 cases treated with MOPP and in all 13 cases given ABVD. Present findings confirm that the two alkylating agents, mechlorethamine and procarbazine, included in the MOPP regimen cause sterility in most patients while the drugs included in ABVD are not associated with permanent gonadal dysfunction.

Semen evaluation in heroin and methadone addicts.

We studied 32 heroin and methadone addicts, divided into 4 groups according to the type of drugs used: 5 heroin-dependent, 10 taking methadone plus heroin more or less constantly, 10 taking methadone plus heroin occasionally, and 7 taking methadone only. 93% of the heroin addicts and 65% of those taking methadone had abnormal semen. The most frequent abnormality was in motility (78%). Teratozoospermia was the second most frequent (28%) and oligozoospermia the third (16%). The 7 patients taking methadone only had neither teratozoospermia nor oligozoospermia. This semen pathology is probably secondary to decreased testosterone production, with relative hypofunction of the seminal tracts and the accessory glands.