6.5 X 11 Double Line.P65

Cambridge University Press 978-0-521-83147-5 - Male Infertility: A Clinical Guide Edited by Anne M. Jequier Index More information

Index

accessory glands, 14–15 antihistamines, 141 candidiasis, 218 acromegaly, 143, 187 anti-hyperlipidaemic agents, cannabis, 142, 204 acrosome reaction, 26 141 capacitation process in sperm, acrosome reaction ionophore anti-hypertensive drugs, 141 25–6, 53 challenge (ARIC) test, antimony caput epididymis, 11 70–1 effects on male fertility, 206 carcinoma-in-situ of the testis, actinomyces, 214 anti-sperm antibodies, 74–6, 89–90, 99, 125, 131 activins, 18 91, 101 testicular biopsy, 124 acute bacterial epididymitis, formation after vasectomy, cauda epididymis, 12 211–12 114–16 Caverjet, 146 acute bacterial epididymo- See also immune infertility cavernosal smooth muscle orchitis, 211–12 arteriosclerosis dysfunction, 140 acute bacterial orchitis, 211–12 role in erectile dsyfunction, cervical mucus acute balanitis, 218 140 detection of anti-sperm acute prostatitis, 215–16 arterio-venous malformation of antibodies, 179 adenocarcinoma, 132 the internal iliac vessels, chancroid ulcers, 218 seminal vesicles, 40 41 Chartpack Chamber, 52 age aspermia, 42 chemotherapeutic agents and male infertility, 5–6 definition, 46 combination chemotherapy, and prevalence of erectile asthenozoospermia, 53 201–2 dsyfunction, 139 causes, 56–9 effects on male fertility, age-related epididymal duct autoimmune infertility, 59 199–202 obstruction, 81 azoospermia chemotherapy, 141 alcohol abuse causes of, 244 cryopreservation of semen effects on male fertility, 204 definition, 46 prior to, 235 alcohol-induced erectile foreseeing the need to store effects on fertility, 96–7 dysfunction, 142 sperm, 244–5 in pre-pubertal boys, 202 Alprostadil, 146 precautions when it is likely, Chlamydia trachomatis, 77, 93, anabolic androgens, 205 244–5 220 and erectile dysfunction, 142 See also surgical collection of Chlamydia trachomatis anatomy of the male genital sperm urethritis, 217 tract. See male genital tract azoospermia factors (AZF), 96 chlorambucil, 200 anatomy azothiaprine, 201 chlordecone, 207 androgen-binding protein chordee, 230 (ABP), 16 beta endorphin, 138 chronic epididymo-orchitis, androgen resistance, 191–2 beta-blockers, 141 212 anterior pituitary gland bilharzia, 93, 214 chronic illness disorders, 183–9 bilirubin in semen, 41 and erectile dysfunction, 142 effects of autoimmune bladder cancer, 40 chronic prostatitis, 216 disease, 184 bleomycin sulphate, 201 Cialis, 146 effects of irradiation, 184 blood in semen, 40–1 cigarette smoking effects of pituitary surgery, brucellosis, 214, 217 co-factor effect in infertility, 184 bulbourethral glands, 15 107 effects of trauma, 184 secretions, 153 effects on male fertility, 205 hemorrhage and vascular role in erectile dysfunction, disturbance, 184 cadmium 140, 143 infiltrations, 184 effects on male fertility, 206 cimetidine, 202 anterior urethral valves, 229 caffeine, 204 cisplatin, 200 anti-androgens, 201–3 Candida albicans, 220 Clermont, Yves, 18 254

Index 255

clotting of seminal fluid, 43–4 cystoscopy, 40 location of the sperm in the cocaine, 204 cytomegalovirus, 78, 213 ejaculate, 155 congenital absence of the vasa cytoplasmic droplets on passage of seminal fluid into deferentia, 76–7, 82, 86 sperm, 63 the posterior urethra, congenital adrenal hyperplasia 153–4 (CAH), 190–1 DDT (dichlorodiphenyltrichlo- propulsion of seminal fluid congenital atresia of the roethylene), 207 down the penile urethra, ejaculatory ducts, 83 depressive illness, 142 154 congenital bilateral absence of diabetes mellitus secretions of the bulbo- portions of the epididymal and erectile dysfunction, 141 urethral glands, 153 duct, 76–7 ejaculatory failure, 160 secretions of the epididymis, corpus epididymis, 11 endocrine infertility, 190 154 corticotrophin releasing retrograde ejaculation, 156 secretions of the prostate hormone, 138 diagnosis gland, 154 Coxsackie group of viruses, 213 importance in male secretions of the seminal cryopreservation of eggs, 253 infertility management, 4 vesicles, 154 cryopreservation of semen dibromodichloropropane secretions of the testis, 154 choice of cryoprotectant, 236 (DBCP), 207 secretions of the urethral cryopreservation procedure, Diff–Quik staining method, glands, 153 236–8 63–4 ejaculatory disorders, 153–64 estimation of cryo-survival, dioxin, 207 ejaculatory failure, 159–63 238 dissemination intravascular neurological control of following vasectomy reversal, coagulation (DIC), 184 ejaculation, 154–5 122 docetaxol (Taxotere), 200 premature ejaculation, 34, foreseeing the need to store doxazosin, 141 134, 142, 163–4 sperm, 244–5 doxirubicin, 200 process of ejaculation, history of, 231 doxycycline, 93 153–4 in severe oligozoospermia, 234 drug-induced erectile failure, retarded or psychogenic men with unreliable 141–2 ejaculatory failure, 164 ejaculation, 235 drugs retrograde ejaculation, 41, methodology, 235–6 effects of chemotherapeutic 43, 155–9 “out of town” husbands, 235 agents, 199–202 ejaculatory duct obstruction, precaution in primary therapies that may cause 42–6, 83–6 testicular disease, 244–5 infertility, 202–3 acquired lesions, 83–4, 86 precaution with azoospermia drugs of abuse clinical presentation, 84–5 risk, 244–5 effects on male fertility, congenital absence of the pre-operative storage of 203–5 vasa deferentia, 86 semen, 245 Dupuytren’s contracture, 228 congenital atresia of the primary testicular disease, 98 ejaculatory ducts, 83 prior to chemotherapy or E. coli, 77, 219 Mullerian duct cyst, 84–5 radiation, 235 Ecstasy (party drug), 205 treatment, 85–6 quarantine period for stored ectopic spleen in the scrotum, utricular cyst, 84–6 semen, 240 133 ejaculatory ducts, 14 range of use in infertility efferent ductules ejaculatory failure, 159–63 management, 234–5 congenital anomalies, 75 causes, 159–60 storage of cryopreserved obstruction of, 75–6 diabetes mellitus, 160 semen, 238–40 post-vasectomy obstruction, semen analysis, 160 storage prior to a vasectomy, 75 sperm collection methods, 234 egg cryopreservation, 253 160–3 thawing the straws, 238 ejaculate spinal cord injury, 159 use in sperm donation, 231 composition of, 29–30 treatment of infertility Cushing’s disease, 143, 187–8 ejaculation, 139 caused by, 160–3 cyclophosphamide, 199 ejaculation process, 29–30, ejaculatory volume, 41–3 cyproterone acetate, 201 153–4 aspermia, 42 cystic ectasia of the rete testis, closure of the bladder neck, effects of ejaculatory duct 75, 133 153 obstruction, 42–3

256 Index

ejaculatory volume (cont.) follistatins, 18 epididymo-epididymostomy, effects of incomplete inhbin B, 17 81 ejaculation, 42 inhibin A, 18 epididymo-orchitis, 77, 92–3 effects of prostatic duct inhibin B, 18 epispadias, 227–8 obstruction, 43 luteinising hormone (LH), erectile dysfunction effects of retrograde 15–16 anatomy and physiology of ejaculation, 43 testosterone, 16–17 erection, 134–8 effects of seminal vesicle Enterococcus faecalis, 219 anatomy of the penis, abnormalities, 42 Enzyme-Linked Immuno- 134–7 effects of vasectomy, 43 Absorbent Assay (ELIZA), definition of erectile failure, estimation by weight, 42 179 134 hyperspermia, 42 eosin stain incidence of erectile failure, hypospermia, 42 test for sperm viability, 134 methods of estimation, 42 59–60 mechanism of erection, nomenclature, 42 eosin–nigrosin stain 138–9 normal range, 41 test for sperm viability, 60–1 possible accompanying normospermia, 42 epididymal cysts, 75 disorders, 134 pathologies which cause epididymal duct obstruction, spinal cord injury, 168–9 reduced volume, 42–3 76–82 erectile dysfunction aetiology, volumetric measurement, age-related, 81 139–43 42 clinical presentation, 76 aging, 139 electron microscopy of collection of sperm for IVF/ arteriosclerosis, 140 spermatozoa, 66–7 ICSI, 81–2 cavernosal smooth muscle Empty Sella syndrome, 185 congenital bilateral absence dysfunction, 140 encephalitis, 181 of portions, 76–7 chronic illness, 142 endocrine infertility, 181–96 dystrophic change in the cigarette smoking, 139–40 acromegaly, 187 epididymis, 81 diabetes mellitus, 141 androgen resistance, 191–2 epididymal microcysts, drug-induced erectile failure, anterior pituitary gland 79–80 141–2 disorders, 183–9 epididymo-epididymostomy, endocrine causes, 140–1 congenital adrenal 81 hyperprolactinaemia, 141 hyperplasia (CAH), Fabry’s disease, 79 inadequate production of 190–1 gonococcal infection, 76 nitric oxide (NO), 140 Cushing’s disease, 187–8 infective epididymitis, neurological impotence, diabetes mellitus, 190 76–8 140 gonadotrophin therapy in infiltrative diseases, 79 prostatic surgery, 140 the hypogonadal male, polyarteritis nodosa, 79 psychogenic erectile failure, 193–4 sarcoidosis, 79 142–3 gonadotrophin-secreting surgical trauma, 79 recreational drugs, 141–2 tumors of the pituitary, trauma-related, 78–9 reduced testosterone levels, 188–9 treatment of infertility 140–1 hemochromatosis, 192–3 caused by, 81–2 venogenic impotence, 142 hyperprolactinemia, 185–7 vaso-epididymostomy, 81 erectile dysfunction clinical hypothalamic disorders, Young’s syndrome, 80 evaluation, 143–4 181–3 epididymal microcysts, 79–80 clinical history, 143 liver disease, 193 epididymis, 11–12 physical examination, 143–4 obesity, 193 efferent ductules, 11 erectile dysfunction testosterone therapy in the epididymal duct, 11–12 investigations, 144 hypogonadal male, 194–6 epididymitis hormonal investigations, 144 thyroid disease, 189–90 bacterial infections, 77 pharmaco-cavernosography, uremia, 193 caused by leprosy, 78 144 endocrinology of the testis, caused by syphilis, 78 the “Rigiscan,” 144 15–18 filariasis, 78 ultrasound examination of activins, 18 tuberculous infection, 78 the penis, 144 follicle stimulating hormone unicellular organisms, 78 erectile dysfunction treatment, (FSH), 17 viral infections, 78 144–52

Index 257

arterial surgery, 151–2 development of the embryo, gr-gr micro-deletions on the intra-cavernosal injection 28 Y chromosome, 96 of prostaglandin E1, fusion of the sperm with the 146–9 oocyte, 26–7 H2 inhibitors, 141 penile prostheses, 149–51 hyperactivated sperm hematoma, 132 phospho-diesterase movement, 26 hematospermia, 40–1 inhibitors, 145–6 sperm binding to the oocyte, hemochromatosis, 192–3 sildenafil (Viagra), 146 26 heat tadalalfil (Cialis), 146 syngamy, 27 effects on male fertility, 198–9 topical and urethral agents, zygote formation, 27 heavy metals 149 filariasis, 78 effects on male fertility, vardenafil (Levitra), 146 flutamide, 201 205–6 vascular surgery, 151–2 focal tubular atrophy, 57 hepatitis B and C, 213 venous surgery, 152 follicle stimulating hormone herbicides erection (FSH), 17 effects on male fertility, 207 anatomy and physiology of, follistatins, 18 heroin addiction, 203 134–8 Foster Kennedy’s syndrome, 96 herpes simplex type 2, 218 neuroendocrine aspects, HIV, 137, 213, 231 137–8 genetic disorders Holoxan, 200 role of nitric oxide (NO), azoospermia factors (AZF), homosexuality 138 96 incidence of anti-sperm role of oxytocin, 138 causes of primary testicular antibodies, 175 erection mechanism, 138–9 disease, 93–6 human chorionic changes in the erectile tissue, Foster Kennedy’s syndrome, gonadotrophin (hCG), 16 139 96 human papilloma virus, 213 ejaculation, 139 gr-gr micro-deletions, 96 hyperactivated sperm neurological control, 138–9 increased numbers of triplet movement, 26, 53 sexual stimulation, 138 repeats, 96 hyperprolactinaemia, 185–7 striated muscle action, 139 karyotypic analysis, 95–6 and erectile dsyfunction, 141 ethylene glycol Kennedy’s syndrome, 96 hyperpyrexia effects on male fertility, Klinefelter’s anomaly, effects on fertility, 92 208 93–4, 97 effects on male fertility, etoposide, 200 micro-deletions on the 198–9 excurrent duct system Y chromosome, 96 hyperspermia, 42 obstruction, 74–87 Noonan’s syndrome, 94–5 hyperviscosity of seminal fluid, ejaculatory duct obstruction, Robertsonian translocations, 44–5 83–6 95–6 hypogonadotropic epididymal duct obstruction, use of donated sperm, 232 hypogonadism, 90 76–82 genital herpes, 213 hypo-osmotic swelling (HOS) intra-testicular obstruction, Giemsa stain, 64 test, 61 74–5 globozoospermia, 64 hypospadias, 89, 226–7 obstruction of the efferent gonadotropin-releasing hypospermatogenesis, 99–100 ductules, 75–6 hormone (GnRH), 16, hypospermia, 42 partial or incomplete 138 hypothalamic disorders, 181–3 obstruction, 86–7 gonadotropin-releasing causes of hypothalamic rete testis, 75 hormone analogues, dysfunction, 181–3 seminiferous tubules, 74 201–3 clinical presentation, 183 unilateral obstruction, 87 gonadotropin-secreting treatment of infertility vasa deferentia, 82–3 tumours of the pituitary, caused by, 183 188–9 Fabry’s disease, 79 gonococcal urethritis, 217 ICSI (intra-cytoplasmic sperm Ferning test, 69 gonorrhoea, 76, 82 injection), 81–2, 231, 232, fertilization of the oocyte, 25–8 gossypol, 203 244 acrosome reaction, 26 granulomatous epididymo- See also IVF/ICSI capacitation process, orchitis, 133 ifosfamide (Holoxan), 200 25–6 granulomatous orchitis, 133 immotile cilia syndrome, 58–9

258 Index

immune infertility, 47, 173–80 pathogenic organisms, Kennedy’s syndrome, 96 actions of anti-sperm 218–20 Klinefelter’s anomaly, 93–4, 97 antibodies, 175–7 penile infections, 217–18 anti-sperm antibodies in prostatic brucellosis, 217 lead cervical mucus, 179 prostatic infections, 215–17 effects on male fertility, 206 causes of anti-sperm seminal vesicle infections, leprosy, 78, 93, 132 antibody formation, 174–5 215 leuprolide acetate, 201 detection of anti-sperm syphilitic infection of the Levitra, 146 antibodies, 177–9 testes, 214 Leydig cells, 15–16 female response to syphilitic ulcers, 218 liquefaction of seminal fluid, spermatozoa, 174 tuberculosis, 214–15 43–4 immunoglobulins which tuberculous prostatitis, liver disease, 193 generate anti-sperm 216–17 lumbar plexus neuropraxia, 166 antibodies, 173–4 urethritis, 217 luteinizing hormone (LH), infertility caused by anti- variola (smallpox), 213 15–16 sperm antibodies, 175–7 vasa deferentia infections, effects of testosterone, 17 tests for anti-sperm 214–15 lymphogranuloma venereum, antibodies, 177–9 vasitis nodosa, 215 218 treatment, 179–80 viral infections, 212–13 lysergic acid diethylamide Immuno-bead test, 177–8 infectious mononucleosis, 213 (LSD), 205 impotence. See erectile infertility dysfunction definition, 1–2 Makler Counting Chamber, incomplete ejaculation, 42 infertility treatments 48–9 infections of the male genital donated sperm, 101 malakoplakia, 133 tract, 211–18 intrauterine insemination, 99 malathion, 207 actinomyces, 214 IVF/ICSI, 101–2 male genital tract anatomy, acute bacterial epididymitis, surgically retrieved sperm, 7–15 211–12 102 accessory glands, 14–15 acute bacterial epididymo- See also sperm donation bulbourethral glands, 15 orchitis, 211–12 inhibin A, 18 ejaculatory ducts, 14 acute bacterial orchitis, inhibin B, 17–18 epididymis, 11–12 211–12 insecticides prostate gland, 14–15 acute balanitis, 218 effects on male fertility, scrotum, 7 acute prostatitis, 215–16 207 seminal vesicles, 14 bilharzia, 214 Insler score, 69–70 testes, 7–11 brucellosis, 214 intra-gonadal axis, 15 urethral glands, 15 candidiasis, 218 intrauterine insemination, 99 vas deferens, 12–14 chancroid ulcers, 218 irradiation male infertility Chlamydia trachomatis effects on male fertility, age-related effects, 5–6 urethritis, 217 197–8 definition of infertility, 1–2 chronic epididymo-orchitis, irradiation therapy interactive factors, 4–2 212 cryopreservation of semen “normal” values for semen chronic prostatitis, 216 prior to, 235 analysis, 4 cytomegalovirus, 213 IVF, 81–2, 232 semen analysis as indicator, genital herpes, 213 capacitation of sperm, 53 2–4 gonococcal urethritis, 217 IVF/ICSI, 101–2 male infertility management hepatitis B and C, 213 for vasectomy-related importance of diagnosis, 4 herpes simplex type 2, 218 infertility, 122 role of testicular biopsy, 6 HIV, 213 retrograde ejaculation, 159 malignant hypertension, 40 human papilloma virus, 213 See also ICSI marijuana, 204 lymphogranuloma melanocyte releasing hormone, venereum, 218 Kallman’s syndrome, 182 138 mumps orchitis, 212–13 Kartagener’s syndrome, melphalan, 201 Neisseria gonorrhoeae 58–9 meningitis, 181 infection, 215, 217 karyotypic analysis of infertile mercury orchitis, 211–12 men, 95–6 effects on male fertility, 206

Index 259

metabolic syndrome, 141 Parkinson’s disease, 160 posterior urethral valves, 229 methotrexate, 201 pathogenic organisms, 218–20 Prader–Labhart–Willi Microcell Chambers, 51 Candida albicans, 220 syndrome, 182 micro-deletions on the Chlamydia trachomatis, 220 premature ejaculation, 34, 134, Y chromosome, 96 E. coli, 219 142, 163–4 microlithiasis in the testis, 130 Enterococcus faecalis, 219 pre-operative storage of sperm, Mixed Antiglobulin Reaction Mycobacterium tuberculosis, 245 (MAR) test, 178 219 priapism, 146, 148, 229–30 morphine, 203 Mycoplasma hominis, 220 primary spermatogenic failure. motor neurone disease, 160 Neisseria gonorrhoeae, 219 See primary testicular Mullerian duct cyst, 84–5 staphylococci, 219 disease multiple sclerosis, 143, 160 Trichomonas vaginalis, 220 primary testicular disease, mumps orchitis, 93, 212–13 Ureaplasma urealyticum, 220 88–102 Mycobacterium tuberculosis, 219 penile disorders and fertility, carcinoma-in-situ of the Mycoplasma hominis, 219 226–30 testis, 99 anterior urethral valves, 229 causes, 88–97 nandrolone, 205 chordee, 230 clinical presentation, 97–8 narcotics addiction and erectile epispadias, 227–8 cryopreservation of semen, dsyfunction, 142 hypospadias, 226–7 98 Neisseria gonorrhoeae infection, Peyronie’s disease, 228 damage from testicular 215, 217, 219 phimosis, 230 biopsy, 92 nerve supply to the testes, 9 posterior urethral valves, 229 effects of chemotherapy, Neubauer Counting Chamber, priapism, 229–30 96–7 49–51 urethral strictures, 230 effects of ischemia, 89 neuroendocrine aspects of urethral valves, 228–9 effects of prolonged erection, 137–8 penile infections, 217–18 hyperpyrexia, 92 neurological disease penis anatomy, 134–7 effects of radiotherapy, 96–7 retrograde ejaculation, 156 arterial supply, 137 effects of X-irradiation, neurological impotence, 140 coverings of the penis, 136–7 96–7 neuropeptide Y, 138 erectile bodies, 134–6 epididymo-orchitis, 92–3 nicotine erectile tissue, 136 genetic causes, 93–6 effects on male fertility, 205 nerve supply, 137 hypospermatogenesis, nitric oxide (NO) venous drainage, 137 99–100 role in erection, 138, 140 peptic ulcer, 142 importance of correct nitrofurantoin, 202 perchlorethylene diagnosis, 102 Noonan’s syndrome, 94–5 effects on male fertility, 208 infection of the testis, 92–3 normospermia, 42 peroxidase stain, 66 orchitis, 92–3 normozoospermia, 46 pesticides precautionary effects on male fertility, 207 cryopreservation of obesity and infertility, 193 Peyronie’s disease, 144, 228 semen, 244–5 oligospermia pH of seminal fluid, 43 testicular histology, 98–9 definition, 46 phenytoin, 202 testicular maldescent, oligozoospermia phimosis, 230 88–91 cryopreservation of semen, phosphodiesterase inhibitors, testicular microlithiasis, 99 234 138, 145–6 torsion of the testis, 91–2 definition, 46 phthalates, 207–8 trauma, 92 opiate addiction, 203 physical properties of seminal treatment of infertility opiate-induced erectile fluid, 40–5 caused by, 99–102 dysfunction, 142 pituitary gland disorders, unknown cause, 88 orchidopexy, 91 183–9 use of testicular biopsy, orchitis, 92–3, 211–12 pituitary tumors, 143 98–9 oxytocin pituitary–hypothalamic– prolactin, 138 role in erection, 138 gonadal axis, 15 drugs which increase polyarteritis nodosa, 79 secretion, 203 paclitaxil (Taxol), 200 polyzoospermia, 58 prostate cancer, 33, 221–5 Papanicolaou stain, 63 definition, 46 as cause of infertility, 224

260 Index

prostate cancer (cont.) psychogenic erectile failure, liqueifaction of seminal fluid, blood in semen, 40 142–3 43–4 digital rectal examination men with ejaculatory failure, (DRE), 222 radiotherapy 160 effects of anti-androgen cryopreservation of semen “normal” values, 4 therapy, 225 prior to, 235 pH of seminal fluid, 43 effects of brachytherapy effects on fertility, 96–7 physical properties of (“close” therapy), 224 ranitidine, 141 seminal fluid, 40–5 effects of pelvic irradiation, recreational drug-induced sperm numbers, 46–52 225 erectile failure, 141–2 urine in semen, 41 effects of radical renal disease, 142 varicocele, 108 prostatectomy, 224 retarded or psychogenic viscosity of seminal fluid, examination, 222 ejaculatory failure, 164 44–5 genetic risk factors, 221 rete testis, 9 volume of an ejaculate, 41–3 hereditary forms, 221 cystic ectasia, 75, 133 semen composition, 29–30 histological confirmation, obstruction, 75, 125 amyloid bodies, 34 223–4 retractile testis, 91 bulbourethral gland life-threatening retrograde ejaculation, 43, secretions, 34 consequences, 221 155–9 calcium, 34 pathology, 222 abnormalities that can citric acid and citrate salts, presentation, 222 mimic, 157 34 pre-treatment causes, 156–7 coagulating polypeptides, 32 cryopreservation of damage to the sympathetic diagnostic use in infertility, semen, 225 outflow, 156 34 prostate-specific antigen diabetes mellitus, 156 fructose, 32 (PSA) test, 222–3 idiopathic, 156 magnesium, 34 prostatic alkaline laboratory diagnosis, 157–8 nitric oxide synthase (NOS), phosphatase (PAP) test, medical treatment, 159 32 222–3 neurological disease, 156 prostaglandins, 32 risk factors, 221–2 retrieving sperm from the prostate gland secretions, trans-rectal ultrasound bladder, 158 32–4 examination, 223–4 surgical damage to the prostate-specific antigen treatment as cause of bladder neck, 156 (PSA), 33 infertility, 224–5 surgical treatment, 159 prostatic acid phosphatase prostate gland, 14–15 urethral obstructive lesions, (PAP), 33 benign hypertrophy, 41 157 proteolytic enzymes, 33 infective disorders, 215–17 urine in semen, 41 seminal vesicle secretions, 32 prostate-specific antigen (PSA), use of IVF/ICSI, 159 spermine, 33–4 33 Robertsonian translocations, testicular and excurrent duct prostate-specific antigen (PSA) 95–6 secretions, 29–32 test, 222–3 urethral gland secretions, 34 prostatic acid phosphatase Salmonella typhi, 77 vesiculase, 33 (PAP), 33 sarcoidosis, 79, 181, 184 zinc, 34 prostatic alkaline phosphatase schistosomal infection, 41 semen microbiology, 209–20 (PAP) test, 222–3 scrotum, 7 expressed prostatic prostatic biopsy, 40 semen secretions technique, 211 prostatic duct obstruction, 43 appearance, 29 identifying the site of prostatic secretions, 154 semen analysis infection, 210–11 prostatic surgery as indicator of fertility, 2–4 identifying white blood cells erectile dsyfunction after, 140 bilirubin in semen, 41 in seminal fluid, 209–10 prostatitis, 33 blood in semen, 40–1 infections of the male genital prune belly syndrome, 90–1 clotting of seminal fluid, tract, 211–18 Pseudomonas infection 43–4 pathogenic organisms, epididymitis, 77 colour of seminal fluid, 218–20 psychogenic ejaculatory failure, 40–1 split ejaculate technique, 164 hematospermia, 40–1 210–11

Index 261

semen sample analysis thickening of the basement blood group testing, 234 correct delivery to the membrane, 126 clinical assessment, 233 laboratory, 37–8 seminoma, 125, 130–2 donor identification issue, correct temperature in the Sertoli-cell-only, 126 241 laboratory, 38 Sertoli cells, 15, 17, 20 payment of, 240 forms to accompany to the sex hormone-binding globulin recruitment, 232–3 laboratory, 38 (SHBG), 17 screening for genetic temperature while in transit sex steroids abnormalities, 233 to the laboratory, 37–8 effects on fertility, 202 screening for infections, 233 semen sample collection, 35–7 Sheehan’s syndrome, 184 screening of potential coitus interruptus method, 37 sheep dip donors, 233–4 containers for collection of effects on health, 207 sperm function tests, 68–73 samples, 36 Shorr stain, 64 acrosome reaction ionophore factors affecting sample sildenafil, 140, 146 challenge (ARIC) test, quality, 35–6 smallpox (variola), 78, 213 70–1 manual masturbation solvents entry into cervical mucus, method, 37 effects on male fertility, 208 68–70 methods of producing a sperm in-vitro sperm-cervical sample, 36–7 location in ejaculate, 155 mucus interaction test, 70 period of abstinence prior to, sperm chromatin dispersion in-vivo post-coital test, 35 (SCD) test, 72 69–70 semen jars, 36 sperm chromatin structure sperm chromatin dispersion silastic condom method, 37 assay, 71–2 (SCD) test, 72 site of production of a sperm collection. See semen sperm chromatin structure sample, 35–6 sample collection, surgical assay, 71–2 time of production of a collection of sperm zona-binding tests, 72–3 sample, 36 sperm donation, 101, 231–43 sperm morphology, 62–7 See also surgical collection of acceptability of, 231 cytoplasmic droplets, 63 sperm. donor identification issue, electron microscopy, 66–7 semen sample collection 241 fibrous sheath dysplasia, 63 artefacts, 38–9 for men who produce no grossly abnormal, 125 altered frequency of sperm, 232 mid-piece abnormalities, 63 ejaculation, 39 for men with genetic range of abnormalities in contaminants, 39 disorders, 232 human sperm, 62 loss of ejaculate, 38–9 legal and ethical issues, sperm head abnormalities, low seminal volume, 38–9 242–3 63 low sperm count, 38–9 methods of insemination, tail abnormalities, 63 reduced sperm count, 39 241–2 sperm morphology assessment reduced sperm motility, 39 need for cryopreservation of “broken necks,” 64 semen samples semen, 231 mid-piece, 64 germinal cells in, 65–6 number of children fathered number of cells examined, 64 identification of white blood by a single donor, 241 significance of abnormalities, cells, 65–6 payment of donors, 240 65 numbers of round cells in, 66 quarantine period for stored sperm heads, 64 seminal vesicles, 14 sperm, 240 staining of sperm, 63–4 adenocarcinoma, 40 screening of potential tails, 64 effects of abnormalities on donors, 233–4 Tygerberg or “strict criteria” ejaculatory volume, 42 situations where it is needed, method, 65 infections, 40 231 sperm movement, 53–6 infective disorders, 215 staffing of a donor acquisition of the ability to seminal vesiculitis, 58 insemination clinic, 241 move, 53 seminiferous tubules, 8–9, 18 where IVF/ICSI is unwanted artefactual causes of poor atrophy, 126 or unacceptable, 232 motility, 56–7 hypercurvature syndrome, sperm donors assessment of, 55–6 74 additional tests in particular asthenozoospermia, 53 obstruction, 74 populations, 234 autoimmune infertility, 59

262 Index

sperm movement (cont.) seminiferous tubules, 18 urological problems caused capacitation process in spermatids, 20 by, 166–9 sperm, 53 spermatogenesis, 18–20 split ejaculate technique, causes of spermatogonia, 18–19 210–11 asthenozoospermia, 56–9 spermatozoa, 20 squamous carcinoma, 132 causes of loss of movement, spermiation, 20 staining sperm for 56–9 spermiogenesis, 20 morphological assessment, effects of seminal vesiculitis, testicular stem cells, 18 63–4 58 time required, 18 staphylococcal infection, 219 effects of varicocele, 58 sperm storage systems, 21 streptococcal epididymitis, 77 effects of vasectomy reversal, sperm structure, 21–3 sulfasalazine (Salazopyrine), 58 head, 21–2 202 hyperactivated sperm mid-piece, 23 surgical collection of sperm, movement, 53–5 mitochondria, 23 244–53 Kartagener’s syndrome, 58–9 neck, 22 alternative to vasectomy linear movement, 54 tail, 23 reversal, 253 mechanisms of movement, sperm transport in the female avoiding the need for, 244–5 53–5 genital tract, 23–5 causes of azoospermia, 244 number of moving sperm, cervix, 23–4 collection from the 55–6 Fallopian tubes, 25 epididymis, 247–9 pathological causes of poor uterus, 24–5 collection from the testis, motility, 57–8 sperm viability determination, 249–51 polyzoospermia, 58 59–61 collection from the vas poor sperm motility, 53 eosin stain test, 59–60 deferens, 245–7 quality grading, 56 eosin–nigrosin stain test, donor sperm as back-up, 253 sperm viability 60–1 egg cryopreservation option, determination, 59–61 hypo-osmotic swelling 253 totally immotile sperm, 125 (HOS) test, 61 sites of surgical sperm sperm numbers, 46–52 spermatic artery, 9 retrieval, 245–51 azoospermia, 46 spermatids, 20 situations where it may be computer-assisted spermatoceles, 75 required, 244 estimation, 52 spermatocytes, 19 timing of a sperm search counting chambers, 48–52 spermatogenic epithelium, 8–9 procedure, 251–2 Makler Counting Chamber, spermatogonia, 18–19 timing of sperm pick-up, 48–9 spina bifida, 89, 160 252–3 methods of estimation, spinal cord injury, 138, 165–72 when no sperm can be 48–52 autonomic hyperreflexia, found, 253 Neubauer Counting 168 surgically retrieved sperm, 102 Chamber, 49–51 bladder atony, 167 syphilis, 78, 93, 132, 214 “normal” sperm counts, 47 causes, 165 syphilitic ulcers, 218 normozoospermia, 46 detrusor dyssynergia, 167–8 oligospermia, 46 ejaculatory failure, 159 tadalalfil, 146 oligozoospermia, 46 erectile dsyfunction, Taxol, 200 polyzoospermia, 46 168–9 Taxotere, 200 reasons for low sperm impact on patients’ lives, 165 teratoma, 132 counts, 47–8 incidence, 165 testes, 7–11 sperm concentration, 46–7 loss of erectile function and blood supply, 9 sperm count and fertility, 47 ejaculation, 165–6 endocrinology, 15–18 terminology, 46 loss of erotic zones, 169 nerve supply, 9 total sperm count, 52 loss of sexual skills, 169 rete testis, 9 units of measurement, 47 management of infertility seminiferous tubules, 8–9 visual assessment on a glass caused by, 169–72 spermatic artery, 9 slide, 48 mechanisms of disruption to spermatogenic epithelium, sperm production, 18–20 sexual function, 166 8–9 primary and secondary sperm collection methods, tunica albuginea, 8–9 spermatocytes, 19 169–72 tunica vasculosa, 8–9

Index 263

testicular biopsy, 98–9, 124–8 racial variations in incidence, tunica albuginea, 8–9 damage caused by, 92 130 tunica vasculosa, 8–9 fine needle aspiration, 126 risk factors, 130 fixation of the testicular seminoma, 130–2 ultrasound examination of the tissue, 128 social variations in incidence, penis, 144 needle aspiration of testicular 130 ultrasound examination of the tissue, 127 squamous carcinoma, 132 testis, 106 open biopsy, 127 staging, 131 undescended testes. possible damage to the testis, teratoma, 132 See testicular maldescent 124 testicular biopsy, 125 Ureaplasma urealyticum, 219 procedural variants, 126–8 testicular dysgenesis, 129 uremia, 193 role in infertility diagnosis, treatment, 133 urethral glands, 15 124 tumor markers, 130 secretions, 153 role in male infertility types of testicular tumor, urethral obstructive lesions management, 6 131–2 retrograde ejaculation, 157 testicular biopsy histological testicular disease. See primary urethral strictures, 230 findings, 125–6 testicular disease urethral valves, 90, 228–9 carcinoma-in-situ, 125 testicular dysgenesis, 89, 129 urethritis, 217 maturational arrest, 126 testicular maldescent, 88–91 urethrotomy, 41 normal testicular tissue, causes, 89–90 urine in semen, 41 125 incidence, 89 utricular cyst, 40, 84–6 seminiferous tubular lesions associated with, 90–1 atrophy, 126 orchidopexy procedure, 91 vardenafil, 146 seminoma, 125 retractile testis, 91 varicocele, 47, 58, 103–11 Sertoli-cell-only, 126 risk of testicular cancer, 130 anatomy of, 104–5 testicular cancer, 125 treatment, 91 clinical diagnosis, 105–6 thickened seminiferous why it causes infertility, 90 clinical examination, 106 tubular basement testicular microlithiasis, 99 co-factor effect in infertility, membrane, 126 testicular torsion, 77 107 testicular biopsy indications, testicular trauma definition, 103 124–5 effects on fertility, 198 endocrine changes, 108 grossly abnormal sperm testicular ultrasound grading, 105 morphology, 125 examination, 106 in the child or adolescent, rete testis obstruction, 125 testosterone, 16–17 111 sperm collection in primary effects of reduced levels, increase in testicular testicular disease, 125 140–1 temperature, 106–7 suspected carcinoma-in-situ effects on LH, 17 ischemia caused by, 107 of the testis, 124 testosterone therapy in the partial obstruction of the totally immotile sperm, hypogonadal male, epididymis, 107 125 194–6 possible ways to cause testicular cancer, 90, 99, 129–33 tetrachloroethylene infertility, 106–7 adenocarcinoma, 132 effects on male fertility, 208 raised level of association with male thyroid disease, 189–90 catecholamines, 107 infertility, 129 torsion of the testis, 91–2 role in infertility, 103–4 conditions associated with, transurethral resection of the semen analysis 130 prostate, 41 characteristics, 108 diagnosis, 131 trauma testicular ultrasound disorders which can mimic, role in testicular disorders, examination, 106 132–3 198 venography, 106 incidence, 129 Trichomonas vaginalis, 220 varicocele treatment, 108–11 lifetime risk, 130 tuberculosis, 82, 93, 132, aim of, 108 metastatic tumors of the 214–15, 219 complications of varicocele testis, 132 tuberculous epididymitis, 78 surgery, 110–11 pre-malignant carcinoma-in- tuberculous prostatitis, 216–17 percutaneous embolisation, situ of the testis, 131 tumors of the pituitary gland, 108–9 presenting symptoms, 130 184–9 surgical ligation, 109–10

264 Index

variola (smallpox), 78, 213 damage to the epididymal vaso-vasostomy procedure, vas deferens, 12–14 epithelium, 116 118–21 vasa deferentia obstruction, granuloma formation, 114 vasectomy-related infertility 82–3 hematoma formation, 114 epididymal sperm collection congenital absence of the infection, 114 and IVF/ICSI, 122 vasa deferentia, 76–7, persistence of sperm in vasitis nodosa, 215 82, 86 ejaculate, 115 vaso-epididymostomy, infective causes, 82–3 post-vasectomy “blow outs,” 76, 81 surgical trauma, 83 116 venogenic impotence, 142 trauma, 83 post-vasectomy pain, 114 venography treatment, 83 vasectomy reversal, 58, 114–23 varicocele, 106 vasectomy, 47 aspects to discuss with Viagra, 140, 146 cryopreservation of semen couples, 118 vinblastine, 200 prior to, 234 complications, 121 viral infections of the genital effects on ejaculatory counseling couples about, tract, 212–13 volume, 43 118 epididymal obstruction, obstruction of the efferent cryopreservation of fertile 78 ductules, 75 semen, 122 viscosity of seminal fluid, reasons for undergoing, 112 factors which affect success, 44–5 rete testis obstruction, 75 118 surgical collection of sperm, follow-up after, 121–2 white blood cells in seminal 253 overview, 122–3 fluid, 65–6 surgical procedural persistent infertility variations, 112–13 following, 122 X-irradiation vasectomy complications, post-operative care, 121 effects on fertility, 96–7 113–17 rate of requests for, 117 anti-sperm antibody reasons for request, 117 Y chromosome micro- formation, 114–16 surgical collection of sperm deletions, 96 changes in testicular as alternative, 253 Young’s syndrome, 80 histology, 117 surgical procedure, 118–21 damage done to the genital time till semen analysis is zona-binding tests, 72–3 tract, 116–17 fertile, 121–2 zona pellucida, 26