On the investigation of men from infertile relations. A clinical study with special regard to anamnesis, physical examination, semen-, hormone- and chromosome analyses, from men with non-"normal" semen.

When investigating men from infertile conjugal relations it is of value early to find variables that give information about the prospects of fertilization, and to know in which patients one needs to analyse serum hormone concentrations and/or chromosomes. A standardized interview and a physical examination were performed prospectively in each case. The findings were compared with the results of a follow-up investigation, with regard to conception rate, performed 3-5 years after the initial investigation. Serum concentrations of FSH, LH, testosterone and prolactin were compared with the results of semen analyses and testicular volume measurements. Mitotic chromosome analyses were performed and the results were compared with the findings in semen. In a selected group of men, extended chromosome analyses--with special regard to the occurrence of induced chromosomal lesions--were performed. The man's age at investigation, sperm density, sperm motility and the duration of the couple's infertility, all gave information about the prospects of conception. A useful score was based on the 'break points' of these four variables, for the estimation of prognosis. Prognostic information was also obtained from total testicular volume and the percentage of morphologically normal spermatozoa (MNS). Men with a long duration of infertility had more frequently azoospermia than the other men. Men with abnormal epididymis(des) had a lower conception rate (CR) than men found normal at physical examination. Otherwise, CR was influenced neither by a positive history of genital disease(s), nor by signs of genital disease(s) at the physical examination. In infertile men with a sperm density of greater than or equal to 20 million spermatozoa/ml and/or a total testicular volume greater than or equal to 30 ml, measurements of FSH, LH and testosterone seem to be of no value. A 'profile' of these hormones, however, does seem to be valuable in men with a sperm density less than 20 million/ml. Prolactin concentration gave no clinically valuable information. Chromosomal aberrations were found in 9.4%. Abnormal karyotypes were absent among men with a sperm density of greater than or equal to 20 million/ml and greater than or equal to 60% MNS. In men with less than 60% MNS there was a significantly increased number of leukocytes with chromosomal lesions.