Male Infertility: IX. Clinical Investigation of the Subfertile Male

Kim, Ha Yeung; Lee, Hee Yong

Abstract

A cumulative clinical investigation was undertaken on subfertile males who were seen in our department during the period from 1955 to 1978. The results obtained were as follows, 1. A total of 2, 117 subfertile males corresponds to 2.8% of total urological out-patients(75,540), and 3.4% of total male out-patients(62,341) for the period of 24 years. 2. A total of 486 subfertile males were hospitalized for corrective surgery. They were 9% of the urological in-patients(5,582) for the same period. 3. Numbers of subfertile male patients are increasing yearly with the ratio from 10 cases(1%) in 1955 to I79 cases(l8%) in 1978(Table 1). 4. Primary infertility was found in 88% of the total subfertile males and the secondary, 12%. 5. Age of subfertile males varied from 22 to 61. the mean being 35, and that of their partners ranged from 24 to 49, the mean being 32(Table 2). 6. Duration of infertile marital life ranged from 1 to 40 years, the mean being 6 years. An average duration of infertile marriage from 1955 to 1959 was 10 years but that of infertile marriage from 1975 to 1978, 4 years(Table 3). 7. Occupation of the subfertile male patients comprised of merchants, farmers, company employees, public officials, engineers, laborers, soldiers, medical doctors, students, and no occupation. Of these, mental workers were 40%, and muscular workers, 60%. 8. An average frequency of sexual intercourse of the subfertile couples revealed 2.2 per week with no significant differences between the infertile group and the normal fertile group(Table 4). 9. According to etiological classification of male infertility, 1) faulty spermatogenesis occupied 22% of total patients; 2) faulty transportation, 35%; 3) faulty seminal composition, 7%; 4) faulty ejaculation, 1%; 5) faulty maturation, 3%; 6) hormonal disturbances, 2%; and idopathic, 30%(Table 5). 10. Suspective etiological factors are listed as follows: Vasectomy reversal was 22%; testicular hypoplasia, 18%; various causes of epididymitis, 12%; pyospermia, 4%; varicocele, 22%; etc(Table 6) 11. Judging from the results of semen analyses, azoospermia was found in 53%, oligospermia, in 29%; and normospermia, in 7% of the 1,876 cases whose semen was examined. In 151 cases, semen analyses revealed normal, but no babies have been born within 1 year of normal marital life even with fertile women. No primary causes were found in 11O cases of azoospermia, and in 410 cases of oligospermia(Table 7) 12. An average value of spermiogramme was as follows: Volume was 2.4ml; count, 93*l000000/ml; motility, 64%; and morphology, 88% in normospermia group, while volume was 2.3ml; count, 24* 10000000/ml; motility, 27%; normal shape, 79% in oligospermia group(Table 8). 13. Findings of testicular biopsies of azoospermias showed that hypospermatogenesis was found in 15% ; peritubular fibrosis, in 26%; germinal arrest, in 15%; germinal aplasia, in 26%; and normospermatogensis with obstructive pattern, in 18% of the 366 azoospermias(Table 9). 14. Single or combined medical therapy with various drugs such as HCG (Puberogen), testosteront ( Miro-depo), liothyronine (Thyronamin), vitamins (Vitamedine), l-arginine, nucleic acid precursor ( AICAMIN). and Korean Ginsen were given to 275 cases out of the 485 idiopathic subfertile patients for the period from 3 to 12 months in order to improve the spermatogenesis. The improved results were obtained from 60 cases out of 141 oligospermias, and from 15 cases out of 134 azoospermias (Tables 10 and 11). The detail results of the medical therapy on the remaining 210 patients will be separately published. 15. Epididymovasostomy was carried out on 124 cases of the bilateral post-inflammatory epididymal obstruction and viable sperm were appeared in 25 cases out of the 82 cases whose semen could be examined but pregnancy occurred only in 11 cases(Table 12). 16. Vasovasostomy was performed on 329 previously vasectomized men and successful results were obtained in 252 cases for patency and in 105 cases for pregnancy out of 300 patients whose semen could repeatedly be tested post-operatively(Table 12).