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OBJECTIVE: To assess the effects of abstinence time on semen parameters in normozoospermic and oligozoospermic men using a large cohort of subfertile men. MATERIALS AND METHODS: From 2002 to 2013, we retrospectively reviewed data from 15,623 patients seen at our fertility clinic. Data on patient age and semen parameters were extracted along with abstinence time. Abstinence time was categorized into 4 groups (≤2 days; >2 and ≤5 days; >5 and ≤7 days; and >7 days). Semen samples were further categorized as normozoospermic or oligozoospermic based on concentration. Age-adjusted linear mixed effect regression models were used to test the effect of abstinence categories on semen parameters. RESULTS: Data from 11,782 encounters (10,095 patients) were used for the final analysis after excluding patients <18 years old, azoospermic samples, and those missing all semen parameters. Mean age was 32.4 (standard deviation: 6.5) and median abstinence time was 4.0 days. There were 9840 normozoospermic and 1939 oligozoospermic samples. In normozoospermic men, longer abstinence was associated with increases in ejaculate volume, concentration, total sperm count, and total motile sperm count. However, in oligozoospermic men, longer abstinence time was not associated with improvements in semen parameters except ejaculate volume. CONCLUSION: The effects of abstinence are different on semen parameters in normozoospermic and oligozoospermic patients. Longer abstinence does not improve most semen parameters in oligozoospermic samples. The World Health Organization recommendations for 2-7 days of abstinence may not be beneficial for subfertile patients when timing is a factor.

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Chromosomal abnormality is the most common genetic cause of infertility. Infertility, as a psychological problem, has received an increasing amount of attention. Psychological interventions have been shown to have beneficial effects on infertile patients with chromosomal abnormalities. The present study explored reproductive outcome of male carriers of chromosomal abnormalities, who accepted genetic counseling and psychological support. Cytogenetic analysis was performed using cultured peripheral blood lymphocytes and G-banding. The detection rate of chromosomal abnormalities was 10.3% in pre-pregnancy counseled males, with polymorphisms being most common, followed by 47,XXY and balanced translocation. Follow-up of 170 carriers with normozoospermia, after 3 years, showed that 94.7% of the cases resulted in live births. In the carriers of polymorphisms, balanced translocation, inv(9), Robertsonian translocation, inversion, and 47,XYY, live birth rates were 96.8, 85.7, 100, 83.3, 75, and 100%, respectively. Follow-up of 54 carriers with oligozoospermia or azoospermia, after 3 years, showed that 14.8% of the cases resulted in live births. In the carriers of 47,XXY with severe oligozoospermia or azoospermia, 80 or 5.9% of the cases resulted in live births, respectively. Therefore, timely psychological support would be beneficial and multidisciplinary approach should be preferentially considered for the management of individuals with chromosomal abnormalities.

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OBJECTIVE: To investigate the relationship between semen quality and state/trait anxiety in patients enrolled in an in vitro fertilization (IVF) program and in control subjects. DESIGN: Cross-sectional study. SETTING: Centre for Reproductive Medicine and Biology, European Hospital, Rome. PATIENT(S): Ninety-four first-attempt IVF patients and 85 age-matched, random subjects recruited in the period July 2006 through March 2008. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Behavioral features of stress, including state and trait anxiety, self-perceived impact of physical disturbance on everyday activities, ethanol consumption, cigarette smoking, and semen parameters such as semen volume, sperm concentration, total count, motility, morphology, and DNA fragmentation. RESULT(S): Increased levels of both state and trait anxiety were associated with lower semen volume, sperm concentration and count, reduced sperm motility, and increased sperm DNA fragmentation of IVF patients, thus influencing seminal parameters at the macroscopic and cellular/subcellular levels. Similar results were obtained in the controls. CONCLUSION(S): Our data confirm previous observations with state anxiety and show that trait anxiety also is negatively associated with male fertility.

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Idiopathic non-obstructive azoospermia or severe oligozoospermia (INOA) consists a special group of men characterized by eugonadism, primary infertility, low testicular volume, azoospermia or severe oligozoospermia and high follicle stimulating hormone values. Aims of this study were to describe the clinical, hormonal, sperm and histological characteristics of men with INOA and to define if and to what extend men with the INOA phenotype carry Y chromosome long arm (Yq) microdeletions. Sixty-three men with INOA were studied through clinical examination, spermiograms, hormonal profile, polymerase chain reaction for Yq microdeletions, karyotype and testicular fine-needle aspiration biopsy. Sixty-seven men with infertility of known causes and sixty fertile men served as controls. Men with INOA had significantly lower total testosterone levels than fertile men as well as higher prevalence of loss of libido, higher luteinizing hormone levels and lower sperm volume whereas men with infertility of known causes had intermediate values. The prevalence of Yq microdeletions was 3% in men with INOA, 3% in men with infertility of known causes (all of them with abnormal karyotype) and 0% in fertile men. In conclusion, men with INOA have more severe testiculopathy than these with infertility of known causes. These men may be at increased risk of developing partial androgen deficiency of the aging male.

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OBJECTIVE: To compare the profile of psychosocial variables in a group of oligozoospermic and normozoospermic men for assessing the hypothesis of a relationship between impaired seminal status and psychosocial factors. DESIGN: Double-blind investigation of the psychosocial differences between oligozoospermics and normozoospermics. SETTINGS: Healthy volunteers in a clinical environment. PATIENT(S): Two hundred eighty men attending their first seminal examination. INTERVENTION(S): We selected 37 oligozoospermic patients on the basis of sperm concentration and 37 normozoospermic controls for comparison. OUTCOME MEASURE(S): Differences in alexithymia (difficulty identifying feelings, difficulty describing feelings, externally oriented thinking), personality traits (extroversion, neuroticism, psychoticism), and coping style toward stressors (task-oriented coping, emotion-oriented coping, avoidance-oriented coping) were assessed in the two groups. RESULT(S): Wilk's Lambda (.79) of the discriminant analysis showed a statistically significant difference between the two groups. The following variables met the inclusion criterion in the discriminant function: psychoticism and difficulty describing feeling. This analysis also showed a high probability of correct classification of oligozoospermic men on the basis of the psychosocial variables. CONCLUSION(S): The relationship between psychosocial variables and seminal status has been confirmed in a group of oligozoospermic and normozoospermic men.

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To evaluate the influence of sexual stimulation via sexually stimulating videotaped visual images (VIM) on sperm function, two semen samples were collected from each of 19 normozoospermic men via masturbation with VIM. Two additional samples were collected from each man via masturbation without VIM. The volume of seminal plasma, total sperm count, sperm motility, percentage of morphologically normal spermatozoa, outcome of hypo-osmotic swelling test and zona-free hamster oocyte sperm penetration assay, and markers of the secretory function of prostate were significantly larger in semen samples collected via masturbation with VIM than masturbation without VIM. The improved sperm parameters in the samples collected via masturbation with VIM may reflect an enhanced prostatic secretory function and increased loading of the vas deferens at that time. In a similar protocol, two semen samples were collected via masturbation with VIM from each of 22 non-obstructed azoospermic men. Semen samples from these men had been occasionally positive in the past for a very small number of spermatozoa (cryptozoospermic men). Two additional samples were collected from each cryptozoospermic man via masturbation without VIM. The volume of seminal plasma, total sperm count, sperm motility, and a marker of the secretory function of prostate were significantly larger in semen samples collected via masturbation with VIM. Fourteen out of the 22 men were negative for spermatozoa in both samples collected via masturbation without VIM. These men demonstrated spermatozoa in both samples collected via masturbation with VIM. Six men with immotile spermatozoa in both samples collected via masturbation without VIM exposed motile spermatozoa in both samples collected via masturbation with VIM. High sexual stimulation during masturbation with VIM results in recovery of spermatozoa of greater fertilizing potential both in normozoospermic and cryptozoospermic men. The appearance of spermatozoa after masturbation with VIM in the vast majority of cryptozoospermic men is of clinical significance in programmes applying intracytoplasmic sperm injections for the management of severe male infertility and obviates the need for testicular biopsy.

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We examined the reported subjective level of pleasure and anxiety usually perceived during the four phases of the sexual sequence by 18 dispermic patients and 18 normal subjects. Relevant differences exist between the two groups in their perception of both emotions. The role of pleasure and anxiety in modulating some reflexive biological responses of the sexual sequence is discussed.

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Five categories of patients suffering from different genetic and non-genetic forms of infertility and three categories of similarly affected, but potentially fertile, clinically normal individuals were studied. The Eysenck's Personality Inventory (1964), Ryle's Marital Patterns Test (1966) and Leckie and Wither's Inventory for Depressive Illness (1967) were used to determine the role played by psychogenic factors in causing infertility. No significant quantitative or qualitative differences were observed in the various groups studied. The psychogenic disturbances present in these individuals appear to be the result of the effect of persisting infertility rather than the cause of it.

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Many chemotherapeutic agents have been shown to cause variable degrees of gonadal dysfunction in both sexes and in all age groups. The severity of the dysfunction depends on the total drug dose and the age at time of therapy. In general, cytotoxic agents produce gonadal dysfunction in men while they produce premature gonadal failure in women. Men develop azoospermia and compensated Leydig-cell function; women sustain ovarian damage causing impaired fertility in the short term and early ovarian failure later. This dysfunction is associated with sexual and emotional difficulties in many patients. In order to discover these problems the physician must sympathetically ask patients and families about their sexual and emotional health. Endocrine and psychologic evaluation help the physician identify the problem. Appropriate counseling and hormone replacement therapy may ameliorate most symptoms and help the patient emotionally adjust to illness and infertility. Prevention of gonadal damage during cytotoxic therapy may be possible in the future. For those young people who retain fertility after cytotoxic therapy, prognosis should be taken into account when counseling about parenthood is given. There is no evidence of genetic abnormalities in the offspring of people previously treated with chemotherapy or irradiation.

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The present investigation deals with the answer to a simple questionnaire from 147 men with azoospermia and 138 men with severe oligozoospermia (sperm counts less than 10 million/ml), earlier admitted to our clinic as male partners in barren couples. Twenty men in the azoospermia group and 52 men in the oligozoospermia group had received different types of infertility treatment. The conception rates reported were 1.6% and 10% in the azoospermia group, and 19.8% and 17.3% in the oligozoospermia group for the untreated and treated subgroups respectively. Only 21% of the men were interested in adoption, whereas 61% answered that they were favourably inclined towards performance of heterologous insemination of their wives. No significant increase in the conception rate was observed in the couples who had achieved adoption. The marriages appeared to be remarkably stable, only 3.5% of the men were divorced or separated from their wives. These results emphasize the necessity of including control groups in treatment trials of male infertility and would also suggest that female partners in these couples should be treated more actively.

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Sixteen couples were interviewed after the male had been discovered to be infertile. Of these couples, 63% of the men had experienced a period of impotence and 87% of the women had experienced rage toward the husband, symptoms, and/or dreams which incorporated three themes: concern for the husband, a wish to be rid of him, and guilt over this wish. Husbands whose wives were symptom-free did not experience impotence. These findings suggest that impotence following the discovery of azoospermia is common and should be regarded as an interactional problem. Clinical management is recommended which includes reassuring the couple that the impotence is expected and that it will resolve within 3 months, and focusing on the couple's reaction to the diagnosis.

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