Fazli Subhan ( National Research Institute of Reproductive Physiology, National Institute of Health, Islamabad. )
Faheem Tahir ( National Research Institute of Reproductive Physiology, National Institute of Health, Islamabad. )
Rashid Ahmad ( National Research Institute of Reproductive Physiology, National Institute of Health, Islamabad. )
Zahir-ud-Din Khan ( National Research Institute of Reproductive Physiology, National Institute of Health, Islamabad. )
Serum of 161 oligospermic men was analysed for pituitary hormones LH and FSH and the androgen testosterone. The hormonal analysis indicated normal levels of LH and testosterone, while the FSH levels showed negative correlation to the sperm concentration (JPMA 45:246, 1995).
Infertility remains a serious social menace for which semen and hormonal analyses are carried out to establish the cause of male infertility1. A low sperm concentration (less than 20 million sperms/nil) is termed as oligospermia2, which is caused either by hormonal disturbances3, resulting in impaired spermatogenesis oroccasionally due to obstructive lesions2. It is, therefore, important to evaluate hormonal concentrations of Luteinising Hormone (LH), Follicle Stimulating Hormone (FSH) and Testosterone for correlation with the sperm concentrations in cases of mild (10-20 million sperms/mi), moderate (5-10 million sperms/mi) or severe (1-5 million sperms/mi) oligospermia. A study was, therefore, carried out in oligospermic men in whom the hormonal concentrations of LH, FSH and testosterone were quantified and correlated with the oligospermic state.
Patients and Methods
Semen samples were collected from the infertile patients between 20 to 50 years of age and analysed for pH volume, morphology, motility and count as described earlier2. Blood was obtained from these patients and serum separated and assayed for LH, FSH and testosterone using Serono Enzyme Immunoassay (EIA) kits. Control samples provided by Sereno were used for quality monitoring of the assay. WHO immunoassay programme version 5.2 was used for calculation of the results, using the 4-parameter logic fitter.
The results are listed in Tables I and II,
which have been divided into three groups on the basis of severity of the oligospermic state. No significant difference was seen in the pH and volume of semen in any of the oligospermic groups or the controls (Table I). Levels of LH and testosterone were within normal limits in all the three groups (Table II). FSH levels were raised in all the three groups, exhibiting a negative correlation with the sperm count (Table II) Difference in FSH significant (p<0.02), while for moderate to severe and mild to severe, the differences were highly significant (p<0.001).
In the present study, the hormonal profile of the subjects characterised as oligospermic after their semen analysis showed an elevated level of FSH and normal levels of LH and testosterone (Table II). The mechanism of oligospermia with high levels of FSH and normal LH and testosterone is an abnormal feedback of gonadal peptides and steroids and the defect in the gonadal axis in the oligospermic men does not reside in the hypothalamic pituitary function but rather in the testis4,5.
Anearlier study carried out in France6, to investigate the function of the hypothalamic-pituitary-testicular axis for men referning for severe oligospermis, also shows similar findings.
Another study7 compared the hormonal profiles of normal and oligospermic men. Mild (10-20 million sperms/mi) to severe (1-5 million sperms/mi) oligospermic subjects were included in the study. Mean LH and testosterone levels were normal, irrespective of the sperm count, while FSH levels were inversely correlated to the spermatozoa concentration. A recent study8 compared serum hormones levels inoligospermic and normozoospennic men and showed an increase in FSH levels, with no significant change in LH and. testosterone levels. Other studies have also reported a significant, but inverse, correlation between FSH levels and sperm concentration9,10.
It has also been demonstrated that there exists an elevation in FSH levels, with normal LH levels, in oligospermic patients11. Similarly, studies have demonstrated no significant difference in LH and testosterone levels between oligospermic and normal individuals12,13.
The results seem to indicate that normal levels of LH and testosterone are responsible for imparting the secondary sexual characteristics in the infertile patients, while the oligospermic state is the result of the elevated FSH concentration which may be due to sertoli cell dysfunction and germ cell aplasia.
1. Guyton, A. C. Textbook of medical physiology. Philadelphia, USA. W. B. Saunders and Company, 1981, pp. 992-1004.
2. Amelar, R. D. Infertility in men. Philadelphia, USA, F. A. Davis Company, 1966, pp. 30-53.
3. Sàfi, S. B., Donaldson, L.A. and Jeffcoate, S. L. WHO Matched Reagent Programme Method Manual. WHO special programme of research in human reproduction, Geneva, Switzerland, WHO, 1992.
4. Avril-Ducame, C., Kuhn. J. M., Bastit, B. et al. Dynamique de Ia secretion gonadotrope dans less oligospermes a FSH isolement eleveee. Presse. Med., 1990;19:1791-1794.
S. Rennet, A., Bujan, L., Plantavid, M. Luteinizing hormone pulse frequency and invitro bioactivity in male idiopathic infertility. Fertil. Steril., 1991 ;55:612-18.
6. Avril-Ducame, C., Kuhn, J. M, Cossec, A. et al. Apport de l’enquete hormonale au choix therapeutique d\\\'une sterilite masculine. J. Gynaecol. Obstet. Biol. Reprod. (Paris), 1990,19:881-888.
7. Fauser, B. C., Rogers, J. W., Hop, W. C. et al. Bioactive and immunoreactive FSH in serum of normal and oligospermic men. Clin. Endocrinol. (Oxf.), 1 990;32:433-42.
8. Hampl, R., Lachman, M., Novak, Z. et al. Serum levels of steroid hormones m men with varicocele and oligospermia as compared to normozoospermic men. Exp. Clin. Endocrinol., 1992;100:117-19.
9. Abbaticchio, G., Nacucchi, 0., Giagulli, V. A. et al. Exploration of the testis in infertile men. Relationships among serum levels ofFSH, LH, 17-alpha-OH-progesterone and testosterone. Andrologia., 1990;22:231-237.
10. Matzkin, H., Homonnai, Z. T, Giliani, D. et al. Serum bioactive and immunóreactive follicle-stimulating hormone in oligospermic and azoospermic men: application of a modified granulosa cell bioassay. Fertil. Steril., 1990;53:709-714.
11. Sharma, R. S., Mokkapati, S., Rajalakshmi, M et al. Serum and semen levels of immunoreactive prolactin, LH and FSH in normospermic, oligospermic and azoospermic men with obstructive infertility prior to and after vasoepididymostomy. Indian J. Exp. Biol., 1992;30:1079-1083.
12. Kassman, K., Arsan, A., Sharer, K. et al. Fonction gonadique et activite genitale des malades transplantes renaux de sexe masculin. Ann. Pedriatr. (Paris), 1991 ;38:405-406.
13. Sevilla-y-Ruiz, A., Moya-Gordillo, C., Torres-Lilli, G. Concentraciones sencas de estradiol y testosterona en pacientes con oligoasternozoospermia y asteno zoospermia. Ginecol. Obstet., (Mex), 1991 ;59:3 13-315.