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Abstract:
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OBJECTIVE: To determine whether immature spermatids increase in semen in
response to hormonal contraceptive treatments. Such a finding would
support the existence of a defect in spermiogenesis, which in turn may
explain the reported variability in sperm output. DESIGN: Semen smears
were obtained from healthy men undergoing randomized control trials of T
plus progestin contraceptive treatments. PATIENT(S): Healthy men (21-49
years) with normal semen analyses received T (50-100 mg IM weekly) in
combination with either desogestrel (150-300 microg daily, n = 5) or
levonorgestrel (125-250 microg daily, n = 10) for 24 weeks. Semen smears
were made during spermatogenic suppression and recovery. Nine control
subjects were also assessed. MAIN OUTCOME MEASURE(S): Semen analyses were
performed using World Health Organization criteria. Immature spermatids
and white blood cells in semen were identified by immunostaining with
monoclonal antibodies to the human intra-acrosomal antigen SP-10 and the
ubiquitous white cell CD-45 antigen, respectively. RESULT(S): In a total
of 14 normal ejaculates (9 control and 5 pretreatment) 74+/-14 million/mL
sperm (mean+/-SEM) were seen together with a few immature spermatids
(0.69+/-0.20 million/mL). During contraceptive treatments, spermatid
number decreased in parallel with the sperm concentration and spermatids
disappeared in most subjects. No significant changes were seen in either
leukocyte or immunonegative round cell concentration (0.41+/-0.25 and
0.25+/-0.09 million/mL in controls, respectively) in response to
treatments. CONCLUSION(S): Spermatid sloughing, as assessed by the
ejaculation of immature spermatids, is not a feature of T-induced
spermatogenic regression in men; rather, the decline in both mature and
immature germ cells in the ejaculate probably results from a decline in
the number of precursor cells, ultimately resulting in severe oligo- or
azoospermia. Detailed studies on the sites of spermatogenic interruption
are required to understand the variability in responses seen after
contraceptive therapies in men. |