[Estimate of the variability in the evaluation of semen analysis]. / Estimación de la variabilidad en la evaluación del análisis seminal.

BACKGROUND: Masculine Infertility diagnosis continues depending in a great number of cases of the analysis of the semen. However, appropriate interpretation of the seminal analysis implies to consider two factors, the dependability of the laboratory and the medical knowledge about the meaning of the seminal alterations. OBJECTIVE: Compare the results of the semen analysis among clinical laboratories. MATERIAL AND METHODS: It was used the semen samples of the patients that need a semen analysis for their study. The sample was collected in the biological fluids assessment laboratory (A) and was evaluated the sperm count, morphology and motility. They were distributed to the other laboratories, andrology laboratory (B) and Assisted Reproduction laboratory (C). It was calculated the coefficients of variation intra-observer and inter-observer and descriptive statistics. RESULTS: It was analyzed 28 semen samples by one technician in laboratory A, one in laboratory B and four in the laboratory C, using the World Health Organization (WHO) recommendations for reporting sperm count, motility and morphology. There is an inter-laboratory variability of the parameters studied in the sperm morphology with statistical difference (p < 0.001). The observed mean coefficients of variation intraobserver (CVs) were 3.6% for sperm count, 20.3%for motility and 9.4% for sperm morphology. The mean CVs inter- laboratory results were as follows: 25.7% for sperm concentration, 52.2% for sperm motility and 82.6% for sperm morphology. CONCLUSIONS: There is an inter-laboratory variability for the analysis of the semen samples between the 3 laboratories studied for the semen parameters studied.

[Prevalence of retrograde ejaculation in infertility associated to hypospermia]. / Prevalencia de eyaculación retrógrada en esterilidad asociada con hipospermia.

BACKGROUND: Approximately 14% of couples of reproductive age have a fertility problem, defined as the inability to achieve pregnancy after a year of frequent intercourse without contraceptive protection. OBJECTIVE: To determine the prevalence of retrograde ejaculation in infertile patients with hypospermia and to establish the effects of the treatment. MATERIAL AND METHOD: Comparative study. A semen analysis of 207 patients with male infertility with hypospermia was performed. The patients with retrograde ejaculation were identified and its prevalence was calculated. Semen parameters were compared before and after treatment by means of a paired-t test. Hormonal levels also were compared between groups with and without retrograde ejaculation by means of a Mann-Whitney U test. RESULTS: Prevalence of retrograde ejaculation was 3.2% out of 2587 infertile patients. Within the group of 207 patients with hypospermia, 84 had retrograde ejaculation. After the treatment the seminal volume increased (from 1.2 to 1.5 milliliters) and the number of mobile cells increased (from 47.2 to 62.5 millions). The number of sperm in urine decreased (from 22 to 10 per high-power field). The patients with retrograde ejaculation had lower levels of follicle-stimulating hormone, luteinizing hormone and testosterone than those without retrograde ejaculation. CONCLUSIONS: Retrograde ejaculation and hypospermia are both considered infrequent but important alterations in infertility. Prevalence of retrograde ejaculation in patients with hypospermia is 40.5%. Treatment increased seminal volume and the number of mobile cells in the ejaculated semen. It is necessary to perform future studies in order to determine the impact of severity of retrograde ejaculation on infertility.

[Potential treatment of infertility with second ejaculate]. / Tratamiento potencial de la infertilidad con segundo eyaculado.

OBJECTIVE: To compare the changes that occurs in the spermatic parameters when a second ejaculate is obtained in the first 60 minutes in patients with a different seminal quality. MATERIAL AND METHOD: Infertile patient from andrology service were asked to provide a second sample within 1 hours of the first. All the patients had poor semen characteristics in volumen, density, motility or total motile cells. RESULTS: The patients were divided in subgroup; hipospermia (n = 75), oligospermic (n = 46), asthenospermic (n = 111) and teratospermic (n = 157). A benefic effect from a second ejaculate sample was observed in patients with asthenosperia, oligospermic and a total motile sperm count less than 10 million (p < 0.05). CONCLUSIONS: The second ejaculate must be considered as an alternative in some infertile patients that are looking for an spontaneous pregnancy or in patients that will require an assisted reproductive techniques and have poor seminal parameters.

[Sperm capacitation with double ejaculate of short interval. A choice in assisted reproduction]. / Capacitación espermática con doble eyaculado de corto intervalo. Una alternativa en reproducción asistida.

In the techniques of assisted reproduction a minimum number of spermatozoa are required, but some patients cannot provide them with one capacitated seminal sample. In this study we investigated if in vitro sperm capacitation of two ejaculates obtained one hour apart from patients with reduced sperm amounts provides an adequate number of spermatozoa. Samples of 75 patients with a low seminal account were processed. They provided one second seminal sample after 60 minutes from the first one. The parameters of the capacitated sample of the first ejaculate (PE) were compared with the parameters of the capacitated sample joining the first and the second ejaculates (PSE). A paired t-test was applied considering a significant value of p < 0.05. Concentration, mobility, total of mobile cells (TCM) and total of mobile cells with normal morphology (ICR) were 31.28 +/-17.65 million/mililiter, 50.45 +/-26.3%, 9.06 +/-7.85 million and 0.64 +/- 0.62 million, respectively in first ejaculate. The respective values in first and second ejaculates were 54.45 +/- 35.06 million/mililiter, 59.39 +/- 25.41%, 17.94 +/- 12.18 million and 1.32 +/- 1.11 million, which represents a significant increase (p<0.05) of 74%, 17%, 98% and 106% respectively. Neither the volume (0.49 +/- 0.037 mililiter versus 0.49 +/- 0.019 mililiter, increase 0%) nor morphology (5.66 +/- 2.76% versus 6.11 +/- 4.88%, increase 7.9%) had a significant change. Sperm capacitation with double ejaculate of short interval must be considered for patients with decreased sperm amounts when deciding the reproductive technique.

[Change of pulsatile release and luteinizing hormone response to naloxone related to testicle damage]. / Cambio en la secreción pulsátil y en la respuesta de la hormona luteinizante a la naloxona en relación con el daño testicular.

OBJECTIVE: To compare the pulsatile release of LH, the tone of endogenous opioids and the mass of LH secreted after a naloxone infusion in healthy subjects and patients with normogonadotropic oligospermia (NO) in a model of progressive testicular damage. PATIENTS AND METHODS: Pulsatile secretion of LH was analyzed in a period of 8 hours in a group of healthy subjects (group 3, n=5), in patients with NO and FSH/LH ratio <1.6 (group 1, n=5) and in patients with NO and FSH/LH ratio >1.6 (group 2, n=5). The area under the curve of LH response after naloxone infusion was also calculated. RESULTS: Free serum testosterone concentration was lower (p < 0.01) and estradiol concentration higher in patients with NO than control subjects (1 vs. 3: p = 0.01; 2 vs. 3: p = 0.001). Frequency of pulses in group 1 was 3.33 +/- 0.57/8 h, in group 2: 4 +/- 1/8 h; and in group 3: 2.66 - 0.57/8 h (2 vs. 3 p < 0.01; 2 vs. 1 p = 0.05). The area under the curve after naloxone infusion was 19,300.44 +/- 11,403.31 in group 1, 5696.09 +/- 1753.44 in group 2; and 3080.97 +/- 1159.78 in group 3 (1 vs. 3 Anova p = 0.01). CONCLUSIONS: The data indicate that patients with NO have a subclinical pantesticular failure and that the opioid tone is increased at the initial phase of testicular dysfunction, but it decreases at more advanced stages of testicular damage.

[Seminal quality and hormones in patients with diabetes mellitus type 2]. / Calidad seminal y hormonas en pacientes con diabetes mellitus tipo 2.

INTRODUCTION: The role of the series of metabolic derangements associated to diabetes mellitus type 2 on the function of the hypothalamic-pituitary-testicular axis and on semen quality is still controversial due in part to the lack of information about the selection criteria of subjects included in previously published studies. This is important due to the high prevalence of occult pathology of the seminal tract. OBJECTIVE: To determine if diabetes mellitus type 2 is related to hormonal or seminal disorders. PATIENTS AND METHODS: In this retrospective study serum concentration of the hormones that regulate the hypothalamic-pituitary-testicular axis and semen quality were analyzed comparatively in patients with diabetes mellitus type 2 and normoglycemic subjects. In both groups occult seminal disorders and conditions associated to the hypothalamic-pituitary-testicular axis dysfunction were discarded. RESULTS: Serum concentration of FSH was higher in patients with diabetes mellitus type 2 than in controls (6.06 +/- 2.28 vs. 4.74 +/- 1.92, p = 0.04). Serum concentration of prolactin was lower in diabetics than in controls (6.71 +/- 1.28 vs. 8 +/- 1.97, p = 0.002). The only seminal abnormality found in patients with diabetes mellitus type 2 was a lower progressive mobility (46.52 +/- 17.77 vs. 58.88 +/- 16.81, p = 0.003). CONCLUSION: This suggests that the patients with diabetes mellitus type 2 have subclinical tubular dysfunction manifested by a low sperm progressive mobility and that this might be associated to subfertility.

[Irregular secretion of prolactin in infertile women with normoprolactinemic galactorrhea]. / Secreción irregular de prolactina en mujeres infértiles con galactorrea normoprolactinémica.

BACKGROUND: Abnormal frequency and pulse amplitud of prolactin secretion in micro and macroprolactinomas has been atributed to a dysfunctional tumoral lactotrope. Previous evidence suggests that non tumoral hyperprolactinemia is caused by a hypothalamic dysfunction. The regularity of prolactin secretion has not been studied with cuantitative methods in patients with normoprolactinemic galactorrhea (NPG) which could be considered an entity that precedes non tumoral and tumoral hyperprolactinemia. OBJECTIVE: To analyze the 24-hour prolactin secretion pattern and its secretion regularity in a group of infertile women with normoprolactinemic galatorea. PATIENTS AND METHODS: A transversal-comparative study was carried out in 6 infertile women with normoprolactinemic galactorrhea and 4 healthy women as controls. The 24 hour prolactin profile, the ratio night time mean concentration/daytime mean concentrattion (NM/DM ratio) and apparent entropy (Ap En, Ap En ratio) were compared in the two groups. RESULTS: Blunting of the nyctohemeral rythm and nocturn hyperprolactinaemia occurred in patients with normoprolactinemic galactorrhea (NPG). NM/DM ratio was lower in patients with NPG than in controls (1.28 +/- 0.25 vs. 1.75 +/- 0.05; p= 0.01). Higher irregularity of prolactin secretion was found in patients with NPG (ApEn: 0.853 +/- 0.158 vs 0.608 +/- 0.171, p=0.04; Ap En ratio: 0.839 +/- 0.11 vs 0.661 +/- 0.14; p=0.04). CONCLUSIONS: The irregularity of prolactin secretion in patients with NPG is not dependant on the presence of a pituitary tumour which suggests that a hypothalamic dysfunction underlies this condition. An irregular secretion and a higher daily mass production of prolactin in patients with NPG could explain both galactorrhea and infertility.

[Changes in a semen analysis related to spontaneous pregnancy in patients with infertility history]. / Cambios seminales relacionados con embarazo espontáneo en pacientes con antecedente de infertilidad.

OBJECTIVE: To describe changes in a semen analysis before getting a spontaneous pregnancy. MATERIAL AND METHODS: In an observational, descriptive, longitudinal and retrospective study a semen analysis of the first evaluation of 96 patients was compared with the exam accomplished before getting a spontaneous pregnancy. A descriptive analysis of the semen exam was performed and the results of both exams were compared by means of at Student test with statistical significance for p < 0.05. RESULTS: In the first analysis, the volume, density, mobility, normal morphology, total number of mobile cells and total number of mobile cells with normal morphology (TNMCNM) were 2.45 +/- 1.39 mL, 79 +/- 43 million/mL, 40 +/- 21%, 27 +/- 14%, 84 +/- 84 million and 23 +/- 29 million, respectively, and in the final analysis were 2.6 +/- 1.26 mL, 79 +/- 42 million/mL, 43 +/- 21%, 28 +/- 14%, 97 +/- 98 million and 28 +/- 33 million, respectively. None of them were different. In four patients with low testosterone and a LH/FS > or = 1 ratio, volume increased from 1 +/- 0.31 to 1.65 +/- 0.17 mL and normal morphology from 22 +/- 7 to 31 +/- 5. Both variables were different. In six patients with high prolactine and low testosterone or low FSH, density increased from 56 +/- 21 to 114 +/- 18 million/mL and TNMCNM from 14 +/- 12 to 46 +/- 32 million. Both variables were different. CONCLUSION: Only those patients with low testosterone and a LH/FSH > or = 1 rate had an increase of semen volume and normal morphology. Those with high prolactine-low testosterone or high prolactine-low FSH had an increase of the total mobile cells and the total mobile cells with normal morphology. There were not changes in any semen variable of the other patients.