Clinical and hormonal characteristics related to male fertility factor of the infertile patients or suspects (n=833) and representative proven fathers (n=48) were studied and evaluated at three infertility clinics. Medical information was obtained on a prescribed proforma. Physical and seminal characteristic variables like 8MI, age, semen volume, pH, liquefaction time, sperm concentration, % of normal and immotile sperm, % of normal and abnormal sperm were determined and calculated (following WHO recommended procedures) in patients classified on WHO criteria based on sperm concentration. Further, concentration of fertility hormones (LH, FSH, PRL, Est., prog., and T) were estimated by standardized procedures in NRIFC RIA laboratory (164 infertile patients and controls). Statistical analyses were performed to find and establish coefficient correlation, if any, among the semen parameters (12 variables) and 6 hormones first in WHO based infertility groups and subsequently in the subgroups of these infertile patients classified on narrow limits of sperm characteristic sperm concentration, sperm motility, sperm morphology and semen volume. The age dependent relationship among the studied parameters was also analyzed. Metabolic indicator, fructose was estimated and the presence of sperm antibodies was tested in representative samples of various infertile categories by commercially available ELIZA kit. Sperm specific lactate dehydrogenase (LDH-C) and its isoenzymes particularly LDH-C4 was studied in infertile patients, vasectomized and control subjects regarding its role as index of fertility.
Semen analysis revealed occurrence of 17% azoospermia, 27.5% oligospermia (mild, 12 %, severe, 10% and moderate 5%), almost 55% normospelmia (including 25% asthenospermia), and <2% impotents and those with low T. There was no relationship of infertility with obesity except an increased tendency of impotency towards it. The patients from Punjab showed of all categories of infertility (maximum asthenospermia), from NWFP and Karachi are prevalent in azoospermia and oligospermia respectively. Semen volume, pH and liquefaction time are either the same or slightly higher in infertile than in the proven fathers (semen volume significantly low in azoospermia and liquefaction lime significantly high in normospermia). Sperm characteristics (sperm motility, morphology and concentration) failed to show any clear demarcation among different categories within themselves or from proven fathers. Sperm morphology was mostly abnormal in oligospermia and asthenospcrmia. but reduced <25%) normal morphology. Asthenospermia is associated with 65% sperm concentration. Impotency and normozoospermia had these characteristics within normal range except decreased motility in the former. Puss cells are observed in fertile but their content was decreased or increased in normospermic and impotent patients respectively. Increase in WBC's was observed both in oligospermic and asthenospermic patients. There may be a slight geographical or temporal variation in some of these parameters. Analysis has been done to find the combination of parameters rather than either sperm concentration or morphology or motility as indicator male fertility. Total LDH reflected a decrease in severe oligo or azoospermic patients. LDH-C4 was absent in azoospermic patients and the patterns H: M ratio calculated from electrophorograms varied according to the sperm density. Role of LDH-C4 as a contributing factor for sperm fertilizing activity has been assessed and it is suggested that its determination may provide a useful criteria for sperm function particularly in those whose spenn count are not dependable index of fertilizing capacity when sperm density is low. Detection of sperm antibodies in seminal plasma showed broad range of variation and there does not appear to be a correlation of its presence or absence with either sperm motility or density.
Mean values (mIU/ml) determined in proven fathers for FSH and LH were 6.33 and 6.63 respectively and those for PRL, T and prog. were 11.9, 4.29 and 0.58 respectively whereas Est (pg/ml) content was 35. I 7; all within reported normal ranges. Significantly higher values of both fSH and LH were found in azoospermia and slightly higher values in oligospermia, whereas no change was observed in asthenospermic and impotent patients. Mean PRL level was slightly lower in azoo. oligo and impotent patients. Asthenopsermic ones did not show any altered hormonal profiles. Est., prog. and T were mostly within the desired values towards minimum range. However, Est. level compared to fertile was rather elevated. It appears that hypogonadotrophic hypogonadism are not identified.
Coefficient correlation calculated between various parameters within each infertile category revealed significant positive one of FSH vs LH in all subjects under study except normozoospermic and those with low T, and of sperm motility vs concentration and vs morphology and of sperm concentration vs morphology only in oligo and astheno, in addition to the fertile subjects. Certain parameters showed this relationship among themselves only in certain infertile categories but not in others. For example. (+ive) between semen volume and both Est and Tin azoo; +ive between age and Est, liquefaction time and PRL while -ive between motility and prog., sperm concentration and FSH in oligo; +ive between semen volume vs PRL, sperm motility vs LH and Est., Est. vs T, whereas -ive between semen volume vs Est, FSH vs morphology and age and puss cells vs both sperm concentration and morphology in asthenospermic patients. The impotent patients showed +ive relationship between PRL, and both age and Est. LII with prog., and T but .ive between prog. and morphology and Est, LH vs PRL and sperm concentration vs age, The semen or hormonal profiles in normospermic and those with low T showed coefficient relationship either insignificant or weak and of varied type except that between sperm motility and morphology. Analysis done to find the combination of parameters among sperm morphology, motility and concentration indicated that sperm morphology and motility appear more reflective of sperm function that either of the two with spenn concentration. It was also apparent that generally ignored features of semen like volume, pH and presence of infection need to be given significant attention in certain categories of infertile patients.
Semen parameters and hormonal profiles were characterized in subgroups of infertile patients classified on the narrow limits of their corresponding values of sperm concentration, motility, morphology, semen volume and age. It was found that among the infertile patients, almost 75% did not have good active sperm motility (>60%), 53% failed to show good sperm morphology (>60%) and about 92% did not have good total sperm motility although only 44% were below desired value of sperm concentration (20 million sperm/ml). The subgroups did not show any sharp or distinct sperm features, mostly in line with those observed in infertile categories. The interrelationship of semen volume, pH, liquefaction time, puss cells as well motility patterns seem important to maintain internal environment for sperm fertilizing capacity. The finding of sperm motility associated with sperm morphology, emphasized that combination of sperm characters primarily sperm motility rather than sperm concentration be given due recognition for evaluation of infertility status. Raised levels of FSH and LH demonstrated by various subgroups - azoo, severe oligo, those with <40% morphology, and <40% motility as well as with <2 ml semen volume emphasized the significant importance of FSH: LH in relation to sperm function. Likewise, slightly elevated level of Est particularly in patients with lower limits of sperm characteristics may suggest their contributory role in some form of male infertility. PRL levels appear related in only those infertile patients, semen volume of which was either <2 ml or >6 m!. Prog. and T did not show any significant variation among different subgroups and their role in sperm function may be of less importance than considered so far.
An attempt was made to calculate coefficient correlation among the parameters of these subgroups of different infertile patients to find characteristic pattern to help in establishing specific differentiation, and it revealed a few conspicuous findings although the nature of significant correlation (positive or negative) varied considerably between different subgroups of each classified category. Further, the correlation between two variables (sperm characteristics and/or hormone) identified in one subgroup failed to show consistency in the succeeding ones and/or in other category of infertile patient, indicating the complexity and specificity of the milieu for sperm function. Among fertile subjects, significant positive correlation was established for FSH vs. LH sperm morphology vs sperm motility (most predominant), sperm concentration vs morphology and sperm motility and spenn concentration, pH vs puss cells, T or sperm motility in only those subjects with 60-250 n million sperm /ml, whereas those with less than these sperm counts showed mostly negative correlation. Further, similar positive correlations were observed in subgroups of different infertile categories with a difference of level of significance. Thus, significant correlations (positive/negative) were observed between semen volume and sperm motility and concentration, and with hormones FSH. LH, PRL, Est. Prog. and T in some but not in others. FSH mostly showed negative correlation with puss cells and sperm morphology with PRL. Likewise, interrelationship among different fertility hormones was also evident with different level of significance in relation to sperm characteristics, though not conclusively documented in all subgroups.
Briefly, significant importance of semen and hormonal profiles particularly the combination of sperm motility, spenn morphology and semen volume, LDH-C4 in association with FSH, LH, PRL and Est. is evident, of course with certain limitations and advantages to provide reliable information in many cases but efforts are desperately needed to establish molecular marker (s) to diagnose precisely the specific category of male infertility.