Free L-carnitine in human semen: its variability in different andrologic pathologies.

Free L-carnitine was assayed in semen from patients with various andrologic diseases by an enzymatic-spectrophotometric method. Extremely low concentrations were found in semen from patients with agenesis of the vas deferens (31.8 +/- 18.8 nm/ml). Semen from men with vasectomies contains a higher concentration of free carnitine (105.0 +/- 8.1 nm/ml). When comparing these data with those of ten fertile control subjects (817.0 +/- 200 nm/ml), we assume that seminal free L-carnitine mainly originates from the epididymis. Semen from patients with azoospermia caused by testicular failure also contains a low carnitine concentration. In hypogonadotropic eunuchoids the gonadotropin treatment increased the low basal concentration. A correlation between semen carnitine content and sperm motility and number was also tested in 124 infertile patients. The results show a positive correlation between free L-carnitine and sperm count (r = 0.617; P less than 0.01), between free L-carnitine and sperm motility (r = 0.614; P less than 0.01), and between free L-carnitine and the number of motile spermatozoa per milliliter (r = 0.646; P less than 0.01).

Cell-mediated immunity in male fertility. Immunological infertility in man.

The leukocyte migration inhibition test on agarose was performed on 210 patients with different andrological disorders: oligozoospermia following primarily testicular disorders, oligozoospermia following primarily non testicular disorders and idiopathic oligozoospermia. This test was most applicable in disorders involving testicular damage and in cases of varicocele with altered blood flow. It would appear that cell-mediated immunity is involved in the pathogenesis of the consequences of these disorders.

Zinc in human semen.

Seminal zinc was measured in normospermic and infertile patients by a new colorimetric method. Analysis of semen from 5 patients with bilateral agenesis of the vas deferens showed high levels of zinc (mean value 1411.2 micrograms/ml). Lower levels were found in 6 patients with monolateral congenital or acquired obstruction (695.2 micrograms/ml). The seminal zinc level in 6 patients who had had a vasectomy or who had an epididymal blockage (125.7 micrograms/ml) was approximately the same as in 41 controls (134.6 +/- 42 +/- SD). Zinc levels were reduced in hypogonadal patients. These data suggest that zinc is secreted mainly by the prostate, while vesicular, epididymal and testicular secretions are devoid of zinc. Evaluation of this metal therefore permits the diagnosis of patency of the seminal pathways, but does not permit identification of prostatitis. No correlation was found between sperm count or motility and the seminal zinc level, nor between the latter and varicocele.

L-carnitine and acetylcarnitine in human sperm with normal and reduced motility.

The differences in the acetylcarnitine/carnitine ratio and the percent of the acetylation in sperm seminal samples have been investigated. The impairment of the enzymatic system controlling the reaction carnitine acetylcarnitine may lead to a defective spermatozoal motility.

Varicocele and male subfertility: prognostical criteria in the surgical treatment.

A retrospective analysis of 324 infertile patients who underwent the surgical treatment of varicocele was conducted. Patients were divided into groups according to the presence or not of other pathological conditions, associated with varicocele: genital inflammation, left testicular hypotrophy, elevated FSH, history of cryptorchidism and azoospermia. Age was also considered. The overall pregnancy rate was 34.2% and the semen improvement was obtained in 181 cases (52.7%). Higher percentages were attained in patients with varicocele only: 56.9% pregnancy rate, 78% sperm improvement. The analysis of the results allowed us to define a prognostical index and to offer the criteria of operability in an infertile patient with varicocele.

Human seminal transferrin: correlation with seminal and hormonal parameters.

Transferrin (TF) concentrations were assessed in semen from 10 fertile controls and 79 infertile patients by a radioimmunoassay method. A positive correlation between seminal TF concentration and sperm count was found in the whole sample of patients and within the control group. A statistically significant difference was found between azoospermic and severely oligospermic patients and all the others. No correlation was found with other seminal parameters or hormonal values.

The treatment of male subfertility with kallikrein.

In a controlled double blind trial the effectiveness and tolerability of Kallikrein in patients suffering from astheno-oligozoospermia was examined in comparison to placebo. 30 patients with astheno-oligozoospermia of idiopathic origin entered the study; they were subdivided into two homogeneous groups of 15 patients each. Group A was treated with 600 K.U. daily for 3 months, group B received placebo tablets. In the Kallikrein group all parameters improved, as sperm motility, volume of semen, sperm concentration, total sperm value, and rate of normal spermatozoa. No changes of endocrinological findings were observed. Three pregnancies occurred in this group. No conceptions were observed in the wives of those patients treated with placebo (group B). Tolerability was very good in all patients.

Clinical study and results of surgical treatment in 146 oligospermic men with varicocele.

Data of 146 infertile men undergoing surgical treatment for varicocele are reported. Patients with the following features were treated by surgery: normal FSH (follicle-stimulating hormone) not severe hypotrophy of the left testis and normal right testis; absence of azoospermia; absence of autosome or sex chromosome alterations; absence of signs of genital inflammation. A clear-cut improvement in the condition of seminal secretion was obtained both in oligospermic patients with less than 10 millions spermatozoa per ml preoperatively, and in patients with a higher number of spermatozoa. Particularly, a marked improvement in the valid motility and morphology of spermatozoa was observed. The biological index of a successful treatment in correcting infertility is represented by the high number (51) of successful pregnancies in the wives of operated patients. It is to be underlined that measurements of spermatic vein pressure, phlebography and intraoperative cineradioscopy completely avoid recurrence that otherwise affects about 5 to 6% of operated patients.