Changes In Testicular Volume Research Articles

Changes in Testosterone Levels Following Surgical Sperm Retrieval in Men with Non-Obstructive Azoospermia: Systematic Review and Meta-Analysis.

Surgical sperm retrieval (SSR) is used to extract spermatozoa for use with intracytoplasmic sperm injection in men with obstructive and non-obstructive azoospermia (NOA). The procedure may lead to segmental devascularization, postoperative fibrosis, and atrophy with a subsequent decrease in testosterone. The aim of the study is to investigate the impact of SSR on serum levels of total testosterone (TT), follicle-stimulating hormone (FSH), luteinizing hormone (LH) testicular volume, and sexual function in infertile azoospermic men. In this systematic review and meta-analysis (SRMA), we searched articles in "PubMed" and "Scopus" exploring the impact of SSR on TT, FSH, LH, and testicular volume. The full-text articles were screened to assess eligibility before data extraction, quality assessment, and meta-analysis. Seventeen studies meeting the inclusion criteria were finally analyzed and included 1,685 infertile, azoospermic men. Patients underwent SSR and were followed in the postoperative period (one week to 32 months). The analysis showed a significant reduction in TT (mean difference [MD] 3.81 nmol/L, 95% confidence interval [CI] 0.55:7.06; p=0.02) compared to pre-SSR values. We also observed insignificant differences in serum FSH (MD 5.08 IU/L, 95% CI -5.6:15.8; p=0.35), LH (MD -2.96 IU/L, 95% CI -6.31:0.39; p=0.08), and no change in testicular volume (MD 0.07 mL, 95% CI -1.92:2.07; p=0.94) after SSR. Sexual dysfunction was associated with hypogonadism, depression, and anxiety, especially in men with unsuccessful SSR and Klinefelter syndrome. The results of this SRMA indicate a significant reduction in TT after SSR. Sexual dysfunction after testicular sperm extraction and the potential negative impact of future SSR repeat should be considered during preoperative counseling.

GNRHR-related central hypogonadism with spontaneous recovery – case report

BackgroundCongenital hypogonadotropic hypogonadism (CHH) is a clinically and genetically heterogeneous disease characterized by absent or incomplete puberty and infertility. Clinical characteristics are secondary to insufficient gonadotropin secretion, caused by deficient gonadotropin-releasing hormone (GnRH) production, secretion, or action. Loss-of-function variants of the gonadotropin-releasing hormone receptor (GNRHR) are associated with CHH without anosmia. CHH was previously considered a permanent condition, but in the past two decades, cases of spontaneous recovery of CHH have been reported. The reversal of hypogonadism in CHH is currently unpredictable, and can happen unnoticed.Case presentationThe male proband was diagnosed with CHH due to compound heterozygosity for two previously reported pathogenic missense variants in the GNRHR gene, NM_000406.2:c.416G > A (NP_000397.1:p.Arg139His) and c.785G > A (p.Arg262Gln) at 16 years of age. In addition to arrested partial puberty, he had a low testosterone level, gonadotropins in the range of early puberty, and a normal inhibin B level. A therapy with increasing doses of intramuscular testosterone undecanoate was received for 2.5 years, while there was no change in testicular volume. At the age of 19 years, testosterone supplementation was interrupted. During the next two years, he had spontaneous pubertal development to achieve a testicular volume of 20 mL, with normal adult levels of gonadotropins and testosterone.ConclusionsGenetic diagnostics can help discriminate congenital hypogonadotropic hypogonadism, deserving therapeutic intervention, from the self-limited constitutional delay of growth and puberty (CDGP). Patients with GNRHR associated hypogonadism can experience spontaneous recovery of the hypothalamic-pituitary–gonadal axis. Spontaneous testis enlargement in patients with central hypogonadism not taking gonadotropins or pulsatile GnRH therapy can indicate recovery of hypogonadism.

Testicular biopsy for fertility preservation in early-diagnosed Klinefelter patients: patient characteristics and long-term follow-up

Research questionWhich early-diagnosed Klinefelter syndrome patients have been offered cryopreservation of testicular tissue as part of fertility preservation before spermatogonial stem cell (SSC) loss? Do these Klinefelter syndrome patients present with behavioural, cognitive and/or psychological problems? Does a testicular biopsy procedure have long-term effects on the gonadal development of Klinefelter syndrome patients? DesignEarly-diagnosed Klinefelter syndrome patients followed between 2009 and 2020 and offered testicular tissue banking in an experimental context at the Universitair Ziekenhuis Brussel were included. The prevalence of behavioural, cognitive and/or psychological problems was determined. Changes in testicular volume and in gonadal function (LH, FSH, testosterone and inhibin B [INHB]) were studied. ResultsOf the 48 Klinefelter syndrome patients included, 22 had testicular tissue removed (biopsy group) and 26 had no surgical intervention (control group). The need for specialized education was significantly higher in prenatally (P = 0.0159) and prepubertally (P = 0.0002) diagnosed Klinefelter syndrome patients. Psychological problems were significantly more prevalent in Klinefelter syndrome patients who did not opt for fertility preservation (P = 0.0447). In the first 4.2 (1.9–9.1) years after testicular biopsy, no difference in testicular volume was observed between the biopsied and the contralateral non-biopsied testes (P > 0.9999). After pubertal onset, no differences in LH, FSH, testosterone and INHB were found between the biopsy and the control groups (P = 0.1324 for LH, P > 0.9999 for FSH, P = 0.5433 for testosterone, P > 0.9999 for INHB). ConclusionEarly-diagnosed Klinefelter syndrome patients presented with behavioural, cognitive and/or psychological problems. Only psychological problems seemed to influence the decision towards fertility preservation. Follow-up data confirm that harvesting testicular tissue does not have a long-term impact on the gonadal development of Klinefelter syndrome patients.

PD29-12 AGE-RELATED CHANGES IN REPRODUCTIVE FUNCTION OF MEN WITH AZOOSPERMIA SUGGEST NONOBSTRUCTIVE AZOOSPERMIA IS A PROGRESSIVE DISEASE

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation II (PD29)1 Sep 2021PD29-12 AGE-RELATED CHANGES IN REPRODUCTIVE FUNCTION OF MEN WITH AZOOSPERMIA SUGGEST NONOBSTRUCTIVE AZOOSPERMIA IS A PROGRESSIVE DISEASE Shoichiro Iwatsuki, Yukihiro Umemoto, Tomoki Takeda, Satoshi Nozaki, Yasue Kubota, Hiroki Kubota, Hiroyuki Kamiya, and Takahiro Yasui Shoichiro IwatsukiShoichiro Iwatsuki More articles by this author , Yukihiro UmemotoYukihiro Umemoto More articles by this author , Tomoki TakedaTomoki Takeda More articles by this author , Satoshi NozakiSatoshi Nozaki More articles by this author , Yasue KubotaYasue Kubota More articles by this author , Hiroki KubotaHiroki Kubota More articles by this author , Hiroyuki KamiyaHiroyuki Kamiya More articles by this author , and Takahiro YasuiTakahiro Yasui More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002030.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Late marriage is a serious social issue in Japan. We reported an increasing trend in the age of men with azoospermia in accordance with late marriage (AUA annual meeting 2020). There is a concern that aging in men with azoospermia has a harmful effect on the reproductive system. However, age-related changes in the reproductive function of such men have not been assessed. Here, we evaluated the relationship between age and testicular volume or reproductive hormone levels in Japanese men with azoospermia. METHODS: This study included 109 men with obstructive azoospermia (OA) and 335 with nonobstructive azoospermia (NOA) who underwent surgical sperm extraction at our institution. Patients with chromosomal aberrancy were excluded. A correlation between patient age and testicular volume, serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), or total testosterone (TT) were assessed. Furthermore, the correlation between age and serum anti-Mullerian hormone (AMH) in 36 and 123 men with OA and NOA, respectively, was also assessed. For statistical analysis, Pearson’s product moment correlation coefficient was used. RESULTS: Serum FSH in men with OA gradually increased with age; however, that in men with NOA was significantly elevated and had no correlation with age. In men with NOA, testicular volume and serum AMH levels significantly decreased with age, but not in men with OA (p<0.05). Serum LH and TT had no significant correlation with age in both groups (Figure). CONCLUSIONS: This is the first report to assess age-related changes in testicular volume and reproductive hormone levels in men with azoospermia. Atrophy of the testis and decreased AMH level indicate degeneration of the seminiferous tubules and Sertoli cell function, respectively. Based on our results, it is suggested that NOA is a progressive disease. Early planning of testicular sperm extraction is necessary for men with NOA. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e531-e531 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shoichiro Iwatsuki More articles by this author Yukihiro Umemoto More articles by this author Tomoki Takeda More articles by this author Satoshi Nozaki More articles by this author Yasue Kubota More articles by this author Hiroki Kubota More articles by this author Hiroyuki Kamiya More articles by this author Takahiro Yasui More articles by this author Expand All Advertisement Loading ...

Gonadotropins for testicular descent in cryptorchid congenital hypogonadotropic hypogonadism males beyond infancy.

To study the effect of combined gonadotropin therapy (CGT) on testicular descent±spermatogenesis in congenital hypogonadotropic hypogonadism (CHH) patients with cryptorchidism beyond infancy. This retrospective cohort study included CHH patients with cryptorchidism [bilateral (n=5) or unilateral (n=1)] treated with CGT for testicular descent±pubertal induction. All participants were treated with CGT [human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG)] with hMG pretreatment in three and monitored for changes in testicular volume (TV), serum total testosterone (T), serum inhibin-B, and sperm concentration. Complete testicular descent to the scrotal position was achieved in 5/6 patients (10/11 testes) after 4.7±1.6months of treatment. There was 44±18%, 97.5% (IQR: 44-195), 10-fold (IQR: 3-19.6), and two-fold (IQR: 1.7-9.3) increase in stretched penile length, ultrasound measured TV, T level, and serum inhibin-B from baseline, respectively. In two pediatric cases, testicular descent occurred with isolated hMG therapy. At the last follow up (median: 23.5, IQR: 10.5-38.7months), all the descended testes remained in scrotal position. In four pubertal/postpubertal age patients, continuous CGT (18-60months) yielded T and inhibin-B levels of 16.64±1.46nmol/l and 106±32.6pg/mL, respectively. All the three patients with available semen analysis had sperm concentration of≥5 million/mL and one of them achieved paternity. A trial of CGT before orchiopexy may be considered in CHH males with cryptorchidism even beyond the narrow age-window of infancy. CGT may also have beneficial effects on future spermatogenesis and fertility outcomes in these patients.

The effect of orcidopexy on increasing testicular volume in undescended testis

Undescended Testis (UDT), a common congenital urological abnormality, which is one of the causes of male infertility. Testicular volume in UDT is significantly smaller than normal testicles. After orchidopexy procedure, testicular volume is expected to increase significantly. The subjects of the study were patients with a diagnosis of UDT palpable which was divided into 2 groups of 0-2 years and over 2 years. Assessment of testicular volume using ultrasound performed before and after surgery. The average age of patients is 6.56±4.248years with the age group 0-2 years are 6 or 20% and> 2 years are 35 or 80%. In the 0-2 years age group, the percentage change in left testicular volume has an average of 14.07 ± 10.590%. In the age group> 2 years, the percentage change in volume of the left testis has an average of 3.19 ± 2.626% with p value = 0.009. In the age group 0-2 years, the percentage change in right testicular volume has an average of 13.25 ± 4.792%. In the age group> 2 years, the percentage change in the volume of the right testis has an average of 5.91 ± 7.012% with p value = 0.042. There is a significant correlation between testicular volume before and after orchidopexy surgery. And changes in testicular volume in the 0-2years age group were more significant than changes in testicular volume in the age group> 2 years

Long-term outcome of Fowler-Stephens surgical treatment in intraperitoneal cryptochidism: single center report

Fowler-Stephens (FS) Surgical treatment is used widely in intraperitoneal cryptorchidism. There is limited long-term follow up data which is necessary to evaluate the efficacy of FS laparoscopic surgeries. Methods: 19 patients with 28 cryptorchid testes managed by two stage FS orchidopexy at the urology department of Children’s Hospital of CQMU from January 2009 to March 2019 were reviewed. Average age was 5.5 years old. All patients were treated with laparoscopic FS stage 1 surgery, and Stage 2 surgery was performed 3-10 months later. Average time between the two stages was 6.4 months. Testicular volume, blood supply, testicular location, adolescent semen analysis, sex hormone levels and secondary sexual characteristics were reviewed at follow up. All surgeries were successful and all testes could be palpated in the scrotum after surgery. All patients were followed up from 1 month to 10 years, except 5 lost to follow-up. Average time of follow up was 2.8 years. During follow up, growth and good blood supply were detected in all testes except one. There was no significant change in testicular volume compared with average level of the respective ages, and no testicular malignant change was observed. 5 children were reviewed after puberty. They showed normal levels of sex hormone and normal secondary sexual characteristics. FS staged surgery is an effective and safe treatment for high cryptorchidism with a high success rate.

Quantification of testicular fat deposition in the evaluation of middle-aged overweight male infertility.

To measure the testicular volume and testicular fat deposition of middle-aged overweight men and to assess the utility of testicular fat deposition and testicular volume in determining and monitoring testicular infertility. Pelvic MRI with thin slice T2WI, T1WI and mDIXON Quant was performed on 30 middle-aged overweight patients in the treatment group and 30 middle-aged overweight men in the control group. Testicular volume and testicular fat deposition were measured separately based on thin slice T2WI and the fat fraction (FF) map of mDIXON Quant, and the testicular fat deposition observed with T1WI was used as a reference for qualitative diagnosis. Testicular volume and testicular fat deposition in middle-aged overweight individuals were compared using a t test with Bonferroni correction and receiver operating characteristic (ROC) curve. The testicular volumes (10.6-17.9 cm3) of individuals in the treatment group were smaller than those (12.6-19.0 cm3) of individuals in the control group (p < 0.05), and the average FF value (2.2-4.6%) of the testes in the treatment group was higher than that (1.5-3.1%) in the control group (p < 0.05). The ROC analysis showed that the area under the curve (AUC) of testicular fat deposition (0.899) was higher than that of testicular volume (0.777), and biopsy and sperm count were used as references to diagnose infertility. The diagnostic sensitivity (90.00%) of testicular fat deposition of the mDIXON Quant sequence was higher than that (50.00%) of the T1W sequence (p < 0.05). Testicular fat deposition was decreased after 6months of active treatment with exercise weight loss and drug treatment, and no significant change in testicular volume was observed 6months later. The findings suggest that the proton density fat fraction (mDIXON Quant sequence in this study) approach is a novel tool for the quantitative and objective evaluation of testicular fat deposition. Testicular fat deposition measurement is more specific than testicular volume measurement in the diagnosis of male infertility, and the mDIXON Quant is more sensitive than T1WI in the diagnosis of testicular fat deposition. Furthermore, our findings may facilitate a more accurate diagnosis and monitoring of testicular infertility, therapeutic effect, and prognosis by measuring testicular fat deposition.

Testicular volume and clinical correlates of hypothalamic-pituitary-testicular function: A cross-sectional study in obese men.

The aim of this study was to determine whether testicular volume is correlated with clinical and biochemical markers of hypothalamic–pituitary–testicular (HPT) axis function. This was a cross-sectional substudy of a larger randomized controlled trial including obese men, body mass index (BMI) ≥30 kg m−2, with a total testosterone level <12 nmol l−1. Testicular volume was measured by orchidometer, testosterone by liquid chromatography/tandem mass spectrometry, and body composition by dual-energy X-ray absorptiometry. Men completed the Aging Males' Symptoms (AMS) score, International Index of Erectile Function-5 (IIEF-5), physical function, and handgrip dynamometer testing. Eighty-nine men participated with a median (interquartile range [IQR]) age of 53.1 (47.6, 59.2) years, BMI of 37.0 (34.6, 40.5) kg m−2, and a total testosterone of 7.0 (6.1, 7.9) nmol l−1. Median testicular volume was 18 (IQR: 10, 20) ml. Testicular volume was negatively correlated with BMI (τ = −0.1952, P = 0.010) and total fat mass (τ = −0.2115, P = 0.005) independent of age and testosterone. When BMI, testosterone, sex hormone-binding globulin (SHBG), and luteinizing hormone (LH) were present in a multivariable model, only BMI (-0.38 ml change in testicular volume per 1 kg m-2 BMI; 95% CI: −0.74, −0.02; P = 0.04) and LH (-0.92 ml change in testicular volume per 1 IU l-1 LH; 95% CI: −1.75, −0.095; P = 0.03) remained independent significant predictors of testicular volume. Testicular volume was positively correlated with IIEF-5 (τ = 0.2092, P = 0.021), but not related to handgrip strength, physical function tests, or AMS. In obese men, testicular volume is inversely and independently associated with measures of adiposity, but not with most clinical or biochemical markers of HPT axis action. From a clinical perspective, this suggests that obesity might compromise the reliability of reduced testicular volume as a sign of androgen deficiency in men.

Assessment of the testicular vascularity after inguinal herniotomy in children: a prospective color Doppler study.

Knowing transient vascular perfusion abnormalities of testes after open inguinal herniotomy procedure is essential for the surgeon who is mainly responsible for the patient outcome. To assess the effect of open inguinal herniotomy procedure on the testicular blood supply in children using duplex ultrasonography (DUS). A prospective observational study included 60 boys (mean age = 9.46 ± 14.46 months; age range = 2 months-6 years) who underwent open inguinal herniotomy operation. Using DUS, the testicular volume, peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were calculated preoperatively and one week, one month, and six months postoperatively. The pre- and postoperative measurements were compared. Statistical analysis was performed using χ2 test, Fisher's exact test, or Student's t-test when appropriate. On physical examination, the hernias were unilateral in 57 boys and bilateral in three boys. Comparison between testicular volumes preoperatively and postoperatively showed no significant change ( P > 0.05). There was a statistically significant increase of PSV and RI one week and one month postoperatively ( P < 0.0001) but returned to be near to the preoperative values at six months. As regards EDV, there was a slight but non-significant postoperative increase ( P > 0.05) which did not return to the preoperative value. The affection of testicular vascularity postoperatively is transient and returns to be near to the preoperative values in the late postoperative period (six months postoperatively). Additionally, no significant change in testicular volume postoperatively.

Letrozole versus testosterone for promotion of endogenous puberty in boys with constitutional delay of growth and puberty: a randomised controlled phase 3 trial

The treatment of constitutional delay of growth and puberty (CDGP) is an underinvestigated area in adolescent medicine. We tested the hypothesis that peroral aromatase inhibition with letrozole is more efficacious than intramuscular injection of low-dose testosterone in inducing puberty in boys with CDGP. We did a randomised, controlled, open-label trial at four paediatric centres in Finland. Boys aged at least 14 years with CDGP who wanted medical intervention and exhibited the first signs of puberty were randomly assigned in blocks of ten to receive either six intramuscular injections of low-dose testosterone (about 1 mg/kg bodyweight) every 4 weeks for 6 months or peroral letrozole 2·5 mg once daily for 6 months. All boys were followed up for 6 months after the end of treatment. The primary outcomes were changes in testicular volume and hormonal markers of puberty at 6 months after treatment initiation, which were assessed in all participants who received the assigned treatment. All patients were included in the safety analysis. This study is registered with ClinicalTrials.gov, number NCT01797718. Between Aug 1, 2013, and Jan 30, 2017, 30 boys were randomly assigned to receive testosterone (n=15) or letrozole (n=15). One boy in the testosterone group was excluded from the primary analyses because of a protocol deviation. During treatment, boys in the letrozole group had higher serum concentrations of luteinising hormone, follicle-stimulating hormone, testosterone, and inhibin B than did boys in the testosterone group. Testicular growth from baseline to 6 months was greater in the letrozole group than in the testosterone group (7·2 mL [95% CI 5·2-9·3] vs 2·2 mL [1·4-2·9]; between-group difference per month 0·9 mL [95% CI 0·6-1·2], p<0·0001). Most adverse events were mild. One boy in the testosterone group had aggressive behaviour for 1 week after each injection, and one boy in the letrozole group had increased irritability at 6 months. Letrozole might be a feasible alternative treatment to low-dose testosterone for boys with CDGP who opt for medical intervention. However, the risks and benefits of manipulating the reproductive axis during early puberty should be weighed carefully. Helsinki University Hospital, Academy of Finland, and Finnish Foundation for Pediatric Research.

151 Associations of Testicular Size and Arterial Blood Flow with Sexual Development and Semen Characteristics in Dorper Rams Raised in a Subtropical Climate

Spectral Doppler (velocimetric) indices are important indicators of blood perfusion and physiological status of internal organs. Doppler ultrasound is used in andrology to assess the blood flow in the testicular arteries, aiding in the diagnosis of scrotal disorders and abnormal spermatogenesis. It was proposed that blood flow indices measured in the testicular artery, namely, blood flow resistance and pulsatility index, were significant predictors of semen quality in clinically healthy dogs. There is a paucity of studies on the associations of testicular morphology and blood flow dynamics with spermatogenesis in growing rams. Forty-five Dorper rams (24 rams aged 8 to 11 months and 21 rams aged 12 to 24 months) were examined using a portable ultrasound scanner connectecd to a linear-array 7.5-MHz transducer. Measurements of the testes were taken with built-in electronic calipers on images containing the largest cross-sectional area of each testicle in 3 planes (coronal, sagittal, and transverse). Colour and spectral Doppler scans were performed immediately after scrotal ultrasonography to detect the testicular arteries and record the following velocimetric indices: peak systolic velocity (PSV, cm/s), end-diastolic velocity (EDV, cm/s), resistive index (RI = [PSV – EDV)/PSV], and pulsatility index [PI = (SPV – EDV)/mean velocity] of the blood vessels. The length (9.7 ± 0.3 v. 9.0 ± 0.2 cm; mean ± SD) of the testes and scrotal circumference (33.3 ± 0.5 v. 31.8 ± 0.4 cm) were greater (P &lt; 0.05) in sexually mature rams than in peri-pubertal rams. There were no differences (P &gt; 0.05) between the 2 age groups of Dorper rams in mean values for blood flow indices measured in testicular arteries. Semen was collected by ejaculation into the artificial vagina from 38% (8/21) of post-pubertal rams and 21% (5/24) of peri-pubertal animals (Chi-squared test; P &lt; 0.05). Semen volume was negatively correlated with PI of the testicular arteries (r = –0.57, P = 0.04). In summary, the attainment of sexual maturity in Dorper rams maintained in a subtropical climate was associated with significant elongation of testes but not with the changes in testicular volume and blood perfusion. Testicular artery PI was a significant predictor of semen volume in peri-pubertal and sexually mature rams. Based on this and several previous studies, B-mode ultrasonography combined with echotextural analyses of the epididymides and accessory sex glands and serum testosterone measurements provide more useful information on the progression of sexual maturation and present semen quality in rams than the ultrasonographic assessment of testicular dimensions and an array of blood flow indices.

Male Reproductive Cycle of a Neotropical Snake,Lygophis anomalus(Dipsadidae), in a Temperate Geographic Distribution

Abstract. The pattern of the testicular cycle and spermatogenic activity of the Neotropical yellow-striped snake Lygophis anomalus in Uruguay was investigated. We gathered data on testicular size, seminiferous tubules, and histological samples of preserved specimens. Testis volume and seminiferous tubule diameter did not differ significantly over the year, and individuals with sperm cells were found all year round. Nevertheless, histological observations show individuals in different stages of spermatogenetic cycle within a single month sample. Our results show that, despite their continuous sperm production, males of L. anomalus populations in Uruguay exhibit a seemingly seasonal cycle, as reflected by changes in testicular volume. Reproductive pattern, even if related to evolutionary lineage, is possibly regulated by environmental factors such as low winter temperatures.

Reduced male fertility in childhood cancer survivors.

With advances in cancer treatment, more pediatric cancer patients have increased their life expectancy. Because cancer-related therapy causes various physical and psychological problems, many male survivors experience later problems with thyroid and sexual functions, and with growth. As outcomes have improved, more survivors need to maintain their reproductive function to maximize their long-term quality of life. Cancer and cancer-related treatment can impair fertility by damage to the testes, to the hypothalamic-pituitary-gonadal axis, or to the genitourinary organs. Prior radiation therapy to the testes, the use of alkylating agents, and central hypogonadism further impair fertility in male survivors of childhood cancer. Following any course of chemotherapy, peripubertal maturation, any testicular volume changes, and symptoms of androgen deficiency should be monitored systematically. If patients request fertility testing, spermatogenesis status can be evaluated either directly by semen analysis or indirectly by determination of the levels of testosterone/gonadotropins and by monitoring any changes in testicular volume. According to the patient's condition, semen cryopreservation, hormonal therapy, or assisted reproduction technologies should be provided.

Reproductive seasonality and the effect of the GnRH agonist deslorelin as a contraceptive in captive male Black Flying-foxes ( Pteropus alecto)

Effective contraception would enhance genetic management of captive Pteropus species, which typically breed well in captivity. Male reproductive seasonality was monitored (15-mo interval) in captive P. alecto (6 controls and 5 treated with 4.7 mg deslorelin). In untreated males, there were seasonal changes in testicular volume, body weight and testosterone secretion; testicular volume and body weight peaked in February and March, respectively, whereas testosterone concentration remained >5 ng/ml before rising (P < 0.001) to 24.9 ± 3.6 ng/ml (mean ± SEM) in April. However, there was no corresponding change in sperm quality, and seminal vesicle gland (SVG) secretions remained present in ejaculates. In treated males, testosterone concentration had an initial ‘flare’ response (mean ± SEM peak: 19.95 ± 3.27 ng/ml) before declining (P < 0.001) by 32 d to basal levels, where it remained. In these males, there was reduced sperm motility after 1 mo (P < 0.001) and the absence of SVG secretions after 4 mo. However, aspermic ejaculates were first recorded 5 mo post-treatment. At 10 mo after treatment, spermatogenesis was still disrupted, when membrane-intact, but non-motile sperm were present in two individuals. Motile sperm were first recovered from one of these males 13 mo after deslorelin treatment. We concluded that captive P. alecto males: (a) had seasonal reproductive changes in testicular volume, body weight and testosterone secretion; (b) produced motile, membrane-intact sperm and SVG secretions throughout the year; and (c) had a rapid decline in testosterone concentration and consequent suppression of testicular function for at least 5 mo following deslorelin administration.

Age-Related Structural and Metabolic Changes in the Pelvic Reproductive End Organs

In this work, we provide preliminary data and a review of the literature regarding normal structural and functional changes that occur in the aging uterus, ovary, testicle, and prostate gland. It is expected that such knowledge will help physicians to distinguish physiologic changes from pathologic changes at an early stage. We retrospectively reviewed pelvic magnetic resonance imaging (MRI) scans of 131 female and 79 male subjects ages 13 to 86 years to determine changes in volume of the uterus, ovary, and prostate gland with age. Scrotal ultrasound examinations of 150 male subjects ages 0 to 96 years also were analyzed retrospectively to determine changes in testicular volume with age. In addition, (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) scans of 145 male subjects ages 11 to 90 years were analyzed retrospectively to assess for changes in maximum standardized uptake value (SUV(max)) of the testicles with age. The uterus had a mean volume of 38.55 +/- 3.68 cm(3) at 17 to 19 years of age, increased to a peak volume of 71.76 +/- 19.81 cm(3) between 35 to 40 years, and then declined to 24.02 +/- 8.11 cm(3) by the eighth decade of life. The maximal ovarian volume per subject maintained a relatively stable size in early life, measuring 9.46 +/- 3.25 cm(3) during the second decade of life, 8.46 +/- 3.32 cm(3) in the mid-fourth decade of life, and 7.46 +/- 3.33 cm(3) at 45 years of age, after which it declined to 4.44 +/- 2.02 cm(3) by the late fifth decade of life. The ovaries were not identifiable on MRI in subjects beyond the sixth decade of life. The volume of the prostate increased from 23.45 +/- 6.20 cm(3) during the second decade of life to 47.5 +/- 41.59 cm(3) by the late eighth decade of life; the central gland of the prostate increased from 9.96 +/- 3.99 cm(3) to 29.49 +/- 28.88 cm(3) during the same age range. Mean testicular volume was 11.2 +/- 5.9 cm(3). Testicular volume increased with age from birth to 25 years. After age 25, there was a significant decline in the testicular volume. The mean SUV(max) for the testicles was 1.9 +/- 0.5. Testicular metabolic activity demonstrated an increasing trend until the age of 35 years. A plateau in SUV(max) was observed after the age of 35 years until the age of 65 years. A slight decrease in SUV(max) was observed after the age of 65 years. The pelvic structures of men and women change both structurally and functionally over the lifespan, and such changes can be quantified using ultrasound, MRI, and (18)F-FDG-PET.

Varicocele and Fertility: Relationship Between Testicular Volume and Seminal Parameters Before and After Treatment

Varicocele is a condition of varicosity and tortuosity of the pampiniform plexus that is often associated with a reduction in the volume of the affected testicle. Today there is much debate about how much the varicocele actually damages the reproductive system and the mechanism through which this occurs. Furthermore, it has not yet clearly been established if treatment is truly useful to restore testicular function. The goal of this study was to evaluate changes in the volume of the affected testis after treatment and to examine any correlations between volume and seminal parameters. We evaluated 43 patients with left idiopathic varicocele with ultrasound scan of the testis before and after surgery; testicular volume was obtained using the ellipsoid formula. We also examined semen parameters before and at an average time of 1 year after the procedure, using the WHO indications. We performed 2 statistical analyses, comparing changes in testicular volume before and after surgery, and volume with seminal parameters. Statistical analysis shows a significant increase of testicular volume after varicocele treatment (P < .05). Furthermore, the total number of spermatozoa and fast progressive spermatozoa rates significantly increased after surgery (respectively P < .05 and P < .01) (Figure 1). The Spearman correlation coefficient shows a good relationship between testicular volume and total number of spermatozoa (r = .445; P = .01). Our data point to the possibility that the affected testicle could benefit in terms of trophism and function after varicocele treatment. Ultrasound scan at follow-up permits assessment of not only the presence of recurrence, but it is also useful for evaluating trophism.

Assessment of reproductive status in male echidnas

This study reports the development and application of techniques to assess the reproductive status of male echidnas. The pattern of testosterone secretion over a 24-h period in five echidnas was documented. Testosterone secretion after injection i.m. of either 1000 IU hCG ( n = 4) or 4 μg GnRH agonist ( n = 6) was determined to establish whether this could be used as a practical index of the prevailing steroidogenic capacity of the testes. hCG (1000 IU) was also used to assess seasonal changes in testosterone secretion in six echidnas over a 13-month period. Seasonal changes in testicular volume were examined by transabdominal ultrasonography. Electroejaculation was attempted to monitor seasonal changes in sperm production, which was also determined by spermatorrhea. There was no apparent diurnal pattern of testosterone secretion in echidnas and circulating concentrations of testosterone remained relatively low (maximum 1.2 ng/mL) and stable over 24 h. Injection of hCG resulted in an increase ( P < 0.01; n = 4) in testosterone concentration with a peak (2.9 ± 0.3 ng/mL) approximately 4 h after injection. GnRH also induced an increase ( P < 0.01; n = 6) in circulating testosterone that was apparent after 1 h (2.6 ± 0.3 ng/mL) and concentrations remained elevated (3.4 ± 0.3 ng/mL) for up to 8 h after injection. Seasonal changes in testosterone secretion determined after injection of hCG, increased ( P = 0.03; n = 6) from late-autumn, peaked in late-winter, and decreased by early-spring. Testicular volume followed a similar seasonal pattern ( P < 0.01; n = 6) with an increase from late-autumn, peak in winter and a decline in mid-spring. There was no seasonal change in live weight. Electroejaculation was attempted throughout two breeding seasons but no semen was obtained. Spermatorrhoea in the echidna was described for the first time and was subsequently used to assess seasonal sperm production. Spermatozoa were found in the urine from June to September. This study has demonstrated that exogenous hormones can be used to obtain an index of the prevailing steroidogenic capacity of the testes in echidnas, which is not apparent with repetitive non-stimulated samples over 24 h. The assessment of testosterone secretion after injection of trophic hormones provides a valuable and practical procedure for the assessment of reproductive status. Testicular ultrasonography and spermatorrhea are useful in assessing reproductive status and in this study were successfully used to determine seasonal reproduction in captive echidnas.

A comparison of the annual cycles in testicular size and moult in captive European starlings Sturnus vulgaris during their first and second years

There is considerable evidence that reproductive success improves with age in birds. It is often suggested that improved performance of older birds is because they are more experienced. Less consideration has been given to the possibility that improvements may be a consequence of age‐related changes in reproductive physiology. One factor that consistently changes with age is laying date – first year birds lay later than older birds. In European starlings Sturnus vulgaris, older males begin reproductive activity earlier than first year males and dominate available nest sites. I monitored changes in testicular volume in captive starlings exposed to natural changes in day length and temperature, from their first autumn through the next two annual cycles. Testicular maturation was advanced by 3–4 weeks in birds during their second year compared to the first, and testicular regression occurred about 2 weeks later. The period of full sexual maturation was 50% longer during the second year. The timing of the post‐nuptial moult was the same. A possible physiological mechanism to explain this is discussed. The results show that earlier reproductive activity in older birds can be explained, at least in part, by intrinsic physiological mechanisms. This does not preclude additional effects of experience of an individual in the improvement in reproductive performance between first and second year birds.

67. Inhibin in the male tammar wallaby, Macropus eugenii

The relationship between the gonadal peptide inhibin and other hormones is well understood in both sexes of eutherian mammals. Inhibin has been barely investigated in marsupials: the inhibin α-subunit gene has been characterised and its expression studied [1]. This study reports the results of two experiments examining the relationship between inhibin, FSH and testosterone in mature male wallabies. Experiment one (N = 7) determined the level of inhibin [2] in male plasma over 18 months, in relation to testosterone [3] and testis volume [3]. Experiment two examined the source of inhibin, its relationship with FSH [4] and testosterone, from non-breeding (May/June) to peri-breeding season (December) in sham-operated (N = 3) and castrated males (N = 3). Male wallabies are capable of inseminating females throughout the year, and seasonality is induced by female receptivity [5]. Inhibin levels rose gradually before the breeding season began (Exp 1), peaking in February and following a seasonal decline (March to May) with testosterone until November, changes unrelated to changes in testicular volume. Like Exp 1, Exp 2 sham males had depressed inhibin and testosterone from May to November, while FSH levels became elevated in June after being low in late breeding season. After castration (Exp 2) inhibin levels fell but did not vanish below assay sensitivity like testosterone, suggesting there are also non-gonadal sources. FSH levels rose quickly post-castration, remaining elevated. These data suggest the testis is a significant source of inhibin in male wallabies, and the role of inhibin in modulating FSH levels requires further detailed study. (1) Vanmontfort, D., et al. (1998) J. Molec. Endocrinol. 21: 141–152; (2) Robertson, D.M., et al. (1988) Mol. Cell. Endocrinol. 58: 1–8; (3) Williamson, P., et al., (1990) J. Reprod. Fertil. 88: 549–557; (4) Moore, L.G., et al., (1997) Gen. Comp. Endocrinol.