Gonadotrophins and male subfertility

Estimate FSH, LH in all male subnormal parameters and plan the tr accordingly :-Male endocrine disorders causing male subfertility and suboptimal sperms -- Male infertility can be categorized on the basis of hormonal status as A)  hypogonadotrophic, B) Eugonadotrophic and C) hypergonadotropic . The integrity of hypothalamic-hypophyseal-testicular (HT-HP-T) axis is generally assessed by measuring serum testosterone luteinizing hormone and follicular stimulating hormone (FSH). LH and FSH are secreted by pituitary in response to gonadotropin-releasing hormone (GnRH), produced by Hypothalamus.

LH stimulates the function of Leydig cells  of the testis present in the interstitial tissue and is responsible for secretion of testosterone FSH stimulates Sertoli cells  situated among the spermatogonia, creating a favorable environment for spermatogenesis. HT and HP also respond to negative feedback of FSH and LH. The feedback of LH secretion is produced by testosterone produced by LC. Inhibin produced by Sertoli cells causes negative feedback of FSH.

A) In hypogonadotrophic hypogonadism (Hypo-Hypo), the FSH and LH are at low levels. A typical hypo-hypo state is seen in Kallmann’s syndrome. This disorder may be a) complete or incomplete. If it is complete both FSH and LH are low. B)  If it  is incomplete deficiency of FSH dominates. The anosmia associated with this condition is due to hypoplasia of the olfactory tracts and bulbs; delayed puberty and Cryptorchidism are usually associated with this syndrome. In condition of isolated FSH deficiency there is normal onset of puberty associated with infertility. Hypo-hypo situation can be helped by administration of pituitary hormone over a protracted period of 6 to 12 months and gonads may be stimulated to function. Hypo-hypo condition is a rare of situation. In the more common eugonadotrophic men with isolated asthenospermia, one should look for previous or present evidence of reproductive tract infection or immunological infertility eugonadotrophic men with azoospermia require detailed evaluation for possibility of obstructive or non obstructive azoospermia.

B) Eugonadotrophic infertility is the most common form of infertility. Majority of men with low sperm count have normal gonadotropic profile. 

C)  Hypergonadotropic hypogonadism is caused by failure of Leydig cells and or Sertoli cells to respond to pituitary gonadotropins. A markedly elevated FSH implies a severe testicular failure and poor spermatogenesis and a markedly elevated LH implies a severe testicular failure and poor spermatogenesis and a markedly elevated LH implies Leydig cell failure resulting in poor production of testosterone . Testosterone supports spermatogenesis, hence deficiency of testosterone also results in oligospermia.

 

  Ejaculatory Dysfunction

Premature ejaculation: this is defined as a condition wirer a man cannot prevent the ejaculation until the desired time. In severe cases ejaculation may occur even before vaginal penetration. In these couples, the problems are dual. There is both failure of sexual function and infertility. But the semen can be utilized for artificial insemination, which can be practiced by the couples themselves. The husband may be thought to collect the semen and introduce it into the vault of the vagina using a syringe.

Ejaculatory Phenomenon

The organ involved in ejaculation are the epididymis, vas deferens, seminal vesicle, prostate, bladder neck and the internal urinary sphincter. In response to sexual stimulation sperms are transported from the storage site in epididymis, distally into vas deferens. During the ejaculatory reflex, the vas deferens furthered propels the sperm rapidly through the ejaculatory duct into the posterior urethra. This forms the first portion of the ejaculate, rich with sperm. This portion can be collected as a split ejaculate for the purpose for the purpose of artificial insemination. The sperm from empty their contents because of sympathetic stimulation. The process of expulsion of seminal fluid into the urethra is termed as seminal emission. At this stage, the sphincter at the bladder neck closes tightly allowing the sperm to propelled along the ejaculatory ducts. Failure of bladder neck closure results in retrograde ejaculation into the bladder.