Seventy-one infertile men were studied for the presence of seminal Leucocytosis, and for the levels of acid phosphatase activity and Chlamydia trachomatis antibodies of iga class using a novel method of Solid-phase radioimmunoassay. The findings were compared with those Of 56 fertile men. Chlamydial iga antibodies were found in the semen Of 51.1% of infertile men with seminal leucocytosis and decreased Seminal acid phosphatase activity, i.e. Those defined as having Asymptomatic chronic prostatitis. This frequency was significantly Higher than among fertile men (23.2%, P less than 0.01) and those Infertile men who had no signs of chronic prostatitis (26.9%, P less Than 0.05). It is concluded that Chlamydia trachomatis seems to be a Common cause of prostatitis and may also interfere with fertility.
We used an indirect solid phase radioimmunoassay to detect and Quantitate immunoglobulin A (iga) in male genital secretions with Specificity for Escherichia coli (E. Coli) antigen. We assayed the Seminal fluid and expressed prostatic secretion (EPS) of a patient With chronic bacterial prostatitis (CBP) due to an 01 E. Coli, the Seminal fluid of 24 fertile men, and the seminal fluid of 62 men of Infertile marriages. Iga directed apparently against the 0-antigen of The infecting E. Coli was measurable in both the seminal fluid and EPS of the CBP patient. Iga in these specimens also bound to antigen In a mix of 8 common E. Coli 0-serotypes that included an 01 E. Coli. Iga with specificity for antigen in the mix of common E. Coli 0-serotypes could not be detected in the seminal fluid of the fertile Men or the men of infertile marriages. These data suggest that Subclinical E. Coli infections of the male reproductive tract are not Commonly associated with infertility.
Microbiological analysis of semen in andrology is mainly performed in Cases of infertility and artificial insemination. In order to Localize the suggested infection and to detect urethral (asymptomatic) colonization, we recommend to analyse additional Specimens of the patient, i.e. Urethral swabs and first portion of Urine. As a rule, quantitative microbiological analysis is necessary In cases of bacteria belonging to the group of potentially pathogenic Flora. In isolating pathogenic ("specific") bacteria, the detection Of a few microorganisms indicates an infectious process. We recommend The careful microscopical examination of the ejaculate to detect Phagocytes, abnormal spermatozoa, trichomonads, yeasts and other Cells. As a rapid microscopical examination we employ the DAPI-fluorochrome-technique. Microbiological cultures should take Into consideration the isolation and identification of ureaplasmas And chlamydia trachomatis. In order to achieve a comparison of Microbiological results with those of other laboratories, it is Essential to define the terms "significant bacteriospermia" and "significant leukocytospermia". In other words, it is necessary to Introduce a borderline between contamination and infection concerning The "nonspecific" potentially pathogenic flora.
Anaerobic and aerobic bacteria in secretions of prostate and seminal Vesicles of infertile men.
Colpi GM; Zanollo A; Roveda ML; Tommasini-Degna A Beretta G
A cytological and bacteriological study was made of prostatic (EPS) And vesicular (EVS) secretions from 123 infertile men who were Suspected of having chronic genital tract inflammation and from 31 Men with premature ejaculation (1,12,16). In the microbiological Investigations samples were inoculated within 10 min on various Culture media and incubated under both aerobic and anaerobic Conditions. Bacterial loads of more than 10,000 colony-forming units Of a single species or genus per milliliter of EPS or EVS were Considered to be pathological. In the infertile subjects with proven Inflammation of the seminal accessory glands, the EPS and the EVS That gave positive cultures and had bacterial loads defined as Pathological contained large numbers of anaerobic or microaerophilic Organisms (EPS: 51 of the 63 bacterial strains found, congruent to 81%; EVS: 19 of the 20 bacterial strains found, congruent to 95%).
During a three years period, evaluation of etiologic factors in 385 Consecutive infertile men revealed chronic prostato-vesiculitis as The commonest cause (25.7%) followed by varicocele (21.8%). In 77% of The patients with chronic prostatitis the authors found a decreased Spermatozoa motility rate. AN obstruction of the sperm duct was found In 7,8%, autoagglutination in 5.7%. Idiopathic infertility was Diagnosed in 10.9% of the patients. The significance of these Findings and the contributions of other causes in this series are Discussed.
Two groups of infertile males (65 and 132 patients) have been Investigated in two different laboratories, with two different Methods to obtain semen. The bacteriological results are quite Similar in the two groups. The microorganisms which have been Isolated are : beta- hemolytic Streptococcus, Proteus, Epidermidis Staphylococcus, Micrococcus, Corynebacter, Viridans streptococcus, Klebsiella, Pseudomonas, Enterobacter, Bacillus, Neisseria, Escherichia coli, anaerobic Staphylococcus, anaerobic Streptococcus, Anaerobic Corynebacter type IV. Fungus, Achromobacter, 20 p. Cent of The patients are chronically infected without any clinical signs. This infection is probably of prostatic origin with an important Number of bacteria in the semen (more than 3 000/ml). No relation has Been shown between the bacteriological data and the physical and Cytological characteristics of the sperm, except the ph : semens with A low ph are generally azoospermic and highly contaminated.
We evaluated 119 male patients for infertility and/or prostatitis. Transabdominal sonography of the seminal vesicles was performed and Transverse sections were used to measure the height and breadth. A Correlation was established with the characteristics of the semen, The volume of semen being related directly to the size of the Vesicles. Male patients with semen abnormalities had seminal vesicles Of greater diameters than those with normal semen. When patients with Prostatitis are eliminated from this group the difference is Insignificant.
Sperm antibody (AB) titers, determined by passive hemagglutination and Cytotoxicity assays, were found to be elevated in 62 males and 46 Females of 103 couples with primary infertility; 15 males and 12 Females of 25 couples with secondary infertility; 10 males and 8 Females of 18 couples with histories of repeated abortion; 21 males And 17 females of 25 couples in which the husband had a history of Prostatitis; and 29 males and 17 females of 38 couples in which the Husband had oligospermia. Of the couples in which one or both Partners had elevated sperm AB titers, only 4 achieved pregnancy: 3 From the group with secondary infertility, all of which ended in Spontaneous abortions, and 1 in which the husband was oligospermic. This suggests an etiologic role of sperm immunity in infertility. Immunosuppressive treatment of autoimmune males with prednisone (15 Mg/day for 3 weeks to 6 months) resulted in significant decreases in AB titers. Pregnancies were achieved by 9 of 25 couples after Treatment (36%). The observed increase in pregnancy rate in the Prednisone-treated versus untreated groups of couples with elevated Sperm AB titers was significant (P less than 0.02).
To investigate the diagnostic value of phosphatases in seminal plasma, The levels of acid phosphatase and alkaline phosphatase were Determined in 15 fertile subjects as well as in 26 cases of Oligoasthenozoospermia. Statistical analysis of obtained data showed That acid phosphatase is a reliable parameter of prostatic function In cases of infection, while alkaline phosphatase may prove to be a Non- specific parameter of subfertile semen. Alkaline phosphatase was Significantly diminished in both oligozoospermia and azoospermia with And without infection or varicocele.
The diagnosis of male adnexitis is difficult and the influence of this Condition on fertility is still a matter of debate. With the Intention to define diagnostic criteria a comprehensive study of Biochemical and morphological features of semen, plus culture for Microorganisms, was performed in patients who were assessed for Infertility during a four year period. The following parameters were Considered of diagnostic value: a) history of urogenital infection And/or abnormal rectal palpation. B) significant alterations in the Expressed prostatic fluid and/or urinary sediment after prostatic Massage. C) 1. Uniform growth of more than 10(3) pathogenic bacteria, Or more than 10(4) non- pathogenic bacteria per ml, in culture of Diluted seminal plasma. C) 2. Presence of more than 10(6) (peroxidase Positive) leucocytes per ml of ejaculate. C) 3. Signs of disturbed Secretory function of the prostate or seminal vesicles. The diagnosis Of infection is accepted if either of the following combinations if Found: a + b, a + c (1 or 2 or 3), b + c (1 or 2 or 3), c1 + c2, c1 + C3, c2 + c3.
In this study, 25 men, referred to our clinic for diagnosis and Therapy of infertility were included. All had enlarged prostates. They were given 10 sessions of prostatic massage during 3--4 weeks And the fluid expressed was analysed for citric acid. The hypertrophy Was seen to recede in almost all cases. Citric acid concentrations Fell in only 6/25 cases analysed. In all the others, values did not Fall and remained relatively stable. There was no apparent Relationship between reduction of prostatic volume and the pattern of Citric acid secretion.
The modern management of male subfertility is based on recognition and Correction of the underlying defect. Treatment starts nonspecifically With improvement in the general environment of spermatogenesis and Any surgical abnormalities are dealt with. If supplementary endocrine Treatment is necessary it is given rationally after estimation of Pituitary and testicular hormone levels. The presence or absence of Antisperm antibodies is established and their effect on sperm Behaviour is observed before and during treatment. Progress in Understanding the complex processes involved in human reproduction Requires careful observation of accurately defined facts. Much Research remains to be done.