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Chronic scrotal hypothermia as a treatment for poor semen

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Abstract

Six men with infertile marriages associated with poor semen and raised testicular temperature were treated by an experimental appliance which exploits evaporation to obtain normal testicular temperatures. This was worn with little discomfort for as long as 24 h a day and for periods as long as 20 weeks. Three wives became pregnant while their husbands were on treatment. Semen analysis at the time of the missed menses showed improvements in all three men. In two patients who did not achieve a pregnancy, semen improvements were also seen after 12 weeks. The improvements in semen quality cannot be attributed to any agency other than the hypothermia; this strengthens the theory that raised temperature plays a role in male infertility. Scrotal hypothermia seems to be a suitable treatment in men with varicocele, varicocelectomy failure, and idiopathic infertility where intrascrotal temperature is raised.

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... Few studies have evaluated the effects of extrinsic scrotal cooling in improving semen parameters and enhancing the potential for fertility (Supplemental Table 1, available online) (10)(11)(12)(13)(14)(15)(16)(17). Devices for scrotal cooling could conceptually be used to treat conditions associated with chronic elevations in scrotal temperature (like varicoceles) or lower the scrotal temperature in men with normal temperatures. ...
... In addition, the oligospermic group had a rise in sperm count after two weeks (10). Since then, there have been eight reported studies on scrotal cooling in men with abnormal semen parameters; all of these demonstrated improvements in sperm counts but only a limited number of studies conducted statistical analyses (10)(11)(12)(13)(14)(15)(16)(17). These eight studies were summarized in a 2013 systematic review (18). ...
... These improvements occurred despite a poor overall compliance with the use of the devices. There was a series of studies that suggested that application of cooling devices to the scrotum had a positive impact on semen parameters (10)(11)(12)(13)(14)(15)(16)(17). Potentially, the cooling devices could be counteracting the effects of chronic heat stress on the testis, or perhaps a lower-than-normal temperature is more supportive of spermatogenesis. ...
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Objective To evaluate compliance of infertile men with the use of scrotal cooling devices. As a secondary objective; sperm parameters, DNA fragmentation, and hormone profiles were examined. Design This exploratory study on scrotal cooling provided men with primary infertility and abnormal semen parameters with scrotal cooling devices. Feedback on the devices was gathered after use of the devices in the form of a questionnaire and semen parameters were examined after device use. Setting Single centre infertility clinic in Toronto, Ontario, Canada. Patients Patients with primary infertility and abnormal semen parameters were prospectively followed pre- and post- scrotal cooling. Interventions One of two scrotal cooling devices ((Underdog ™) or (Snowballs ™)) were used, based on patient preference. Main Outcome Measures Questionnaires were completed by patients on compliance with device use and concerns about and recommendations for improving the cooling devices. Baseline DNA fragmentation index, sperm parameters and hormones were measured at initial visit (t=0) and at subsequent visits (t=4-12 weeks). Statistical comparison of values pre- and post- scrotal cooling was performed. Results 40 patients were enrolled in the study and the questionnaire was completed by 65.0% (n=26). A majority of respondents (76.9%) utilized scrotal cooling less than the recommended duration. Respondents felt the devices were uncomfortable (31.5%), impeded work (21.0%) and lost cooling rapidly (14.3%). A significant increase in sperm motility and vitality (25.4 % to 29.0% (p=0.017) and 64.8% to 71.7% (p=0.031) respectively) was demonstrated post-scrotal cooling. Conclusions Most patients were not compliant with the recommended use of the scrotal cooling devices due to issues of comfort, convenience and concealability. Further work improving scrotal cooling devices is necessary to enhance its potential as a therapeutic tool for men with abnormal sperm parameters and infertility.
... Regarding feasible and practicable strategies to improve semen quality, a different approach seems promising. Taking the same line, Zorgniotti et al. [6] and Jung et al. [7] described a pragmatic approach of cyclic intermittent scrotal cooling leading ...
... It is well known that elevated scrotal temperature is linked to male infertility [3]. The range of physiological scrotal skin temperature has been described between roughly to significantly increased semen quality [6,7]. However, the lack of suitability for daily use of testicular cooling devices based on external air pumps and fluid reservoirs limited a widespread utilization [6]. ...
... The range of physiological scrotal skin temperature has been described between roughly to significantly increased semen quality [6,7]. However, the lack of suitability for daily use of testicular cooling devices based on external air pumps and fluid reservoirs limited a widespread utilization [6]. Recently, the idea of scrotal cooling to improve fertility was taken up to investigate improvement of semen quality in mice after cisplatin-induced spermatogenesis toxicity and confirmed a significant positive effect [8]. ...
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Introduction Male reproductive health is rapidly declining during the past decades and it is well known that scrotal temperature is linked to male infertility. Material and methods We performed a prospective data evaluation within a counterfactual analysis study design. Scrotal cooling was performed using Snowballs™ underwear, scrotal temperature was monitored using a wireless temperature sensor (SensorPush, Brooklyn, NY, 11215) Results Overall, scrotal skin temperatures were monitored for 1008 hours. Median scrotal skin temperature was 34.6°C (IQR 33.1 to 35.3) and 35.3°C (IQR 34.4 to 35.9) in the experimental (SnowWedge™) period and control period, respectively, which was significantly different (P <0.001). Conclusions Cyclic scrotal skin cooling using specialized underwear is feasible and efficacious without impairing the activities of daily living and reduces median scrotal skin temperature significantly by 0.7°C. Given the proven association of scrotal skin temperature and semen quality, cyclic scrotal skin cooling by a device such as Snowballs™ underwear may eventually increase semen quality and fertility.
... On the other hand, Wright (28) has demonstrated the efficacy of varicocelectomy in restoring testicular temperature in humans. The latter study, taken together with the conclusions of the studies by Zorgnioti (29,30), indicating that chronic scrotal hypothermia may be a treatment for poor semen quality, allows us to suggest that performance of varicocelectomy may alter cases of severe spermatogenic arrest to an oligospermic phenotype attributable to a decrease in intratesticular temperature. Furthermore, varicocelectomy has been accompanied by an increase in Leydig cellular secretory function resulting in increased peripheral serum testosterone profiles (31)(32)(33)(34)(35)(36) and subsequently a more optimal stimulation of the Sertoli cellular secretory function. ...
Article
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The knowledge on male reproduction is constantly expanding, especially in treating infertility due to non-obstructive azoospermia (NOA). Varicocele is occasionally diagnosed in a subpopulation of males with NOA. Varicocele repair in NOA-men may contribute to the reappearance of spermatozoa in semen. However, spontaneous pregnancies are observed in only a small percentage of NOA-men post-varicocelectomy. Additionally, it has been reported that the repair of varicocele in NOA-men (before the performance of sperm retrieval techniques) may increase the testicular sperm recovery rate. In addition, it increases the pregnancy rate in intracytoplasmic sperm injection (ICSI) programs in NOA-men without spermatozoa in the semen post-varicocelectomy. In addition, to the improvement in Sertoli cellular secretory function, varicocelectomy may increase the secretory function of Leydig cells, which subsequently results in improved androgen production, raising the probability to negate the need for testosterone replacement therapy in cases of late-onset hypogonadism. On the other hand, the benefit of varicocelectomy in patients with NOA is still debatable. The current review study aims to provide a critical and extensive review of varicocele repair in males with NOA. This study additionally focuses on the impact of varicocele repair on sperm retrieval rates and its influence on the ICSI outcomes for those couples who remain negative for spermatozoa in their semen samples post-varicocelectomy.
... As discussed above, scrotal hyperthermia may be an underlying mechanism for the negative fertility outcomes from certain environmental exposures. Scrotal cooling has been investigated as a way to improve semen parameters in the setting of hyperthermia induced by varicoceles and has been shown to improve semen parameters including sperm concentration, motility and morphology (141,142). More recently, a systematic review by Nikolopoulos and colleagues in 2013 reviewed the evidence associating scrotal cooling with changes in semen parameters (143). ...
Article
Idiopathic infertility is the most common individual diagnosis in male infertility, representing nearly 44% of cases. Research studies dating over the last half-century consistently demonstrate a decline in male fertility that is incompletely explained by obesity, known genetic causes, or diet and lifestyle changes alone. Human exposures have changed dramatically over the same time course as this fertility decline. Synthetic chemicals surround us. Some are benevolent; however, many are known to cause disruption of the hypothalamic-pituitary-gonadal axis and impair spermatogenesis. More than 80,000 chemicals are registered with the United States National Toxicology Program and nearly 2,000 new chemicals are introduced each year. Many of these are known toxins, such as phthalates, polycyclic aromatic hydrocarbons, aromatic amines, and organophosphate esters, and have been banned or significantly restricted by other countries as they carry known carcinogenic effects and are reproductively toxic. In the United States, many of these chemicals are still permissible in exposure levels known to cause reproductive harm. This contrasts to other chemical regulatory legislature, such as the European Union's REACH (Registration, Evaluation, Authorization and Restriction of Chemicals) regulations which are more comprehensive and restrictive. Quantification of these diverse exposures on an individual level has proven challenging, although forthcoming technologies may soon make this data available to consumers. Establishing causality and the proportion of idiopathic infertility attributable to environmental toxin exposures remains elusive, however, continued investigation, avoidance of exposure, and mitigation of risk is essential to our reproductive health. The aim of this review is to examine the literature linking changes in male fertility to some of the most common environmental exposures. Specifically, pesticides and herbicides such as dichlorodiphenyltrichloroethane (DDT), dibromochloropropane (DBCP), organophosphates and atrazine, endocrine disrupting compounds including plastic compounds phthalates and bisphenol A (BPA), heavy metals, natural gas/oil, non-ionizing radiation, air and noise pollution, lifestyle factors including diet, obesity, caffeine use, smoking, alcohol and drug use, as well as commonly prescribed medications will be discussed.
... Repeated cold washings of the genitals has been recommended as another means of scrotal cooling (Davidson, 1954), but pertinent studies are not available. To date, only an evaporative cooling device for reduction of scrotal temperature has been developed for use in practice (Zorgniotti et al., 1980Zorgniotti et al., , 1982Zorgniotti et al., , 1986). The cooling effect is achieved by evaporation of water from a body-worn reservoir, which is continuously emitted into a scrotal covering. ...
Article
A questionnaire assessing factors that might cause an increase in scrotal temperature was completed by patients with reproducible oligoasthenoteratozoospermia of idiopathic nature or caused by varicocele. Evaluation by means of a grading scale revealed increased scrotal heat stress in oligoasthenoteratozoospermic patients compared with normozoospermic men (P < 0.01). In addition, long-term determination of 24 h scrotal temperature profiles showed that compared with semen donors, oligoasthenoteratozoospermic patients frequently had scrotal temperatures above 35.5 degrees C despite the same environmental temperatures (P < 0.05). In 88% of cases, maximum scrotal temperatures were measured during rest or sleep phases, whereas minimum values were recorded during physical activity or frequent change of position. Nocturnal scrotal cooling by means of an air stream resulted in a decrease in scrotal temperature of approximately 1 degrees C. Furthermore, a highly significant increase in sperm concentration (P < 0.0001) and total sperm output (P < 0.0001) was achieved after nocturnal scrotal cooling for 12 weeks together with a moderate decrease in factors leading to genital heat stress. A significant improvement in sperm motility (P < 0.05) and sperm morphology (P < 0.05) was also observed, but this improvement was markedly less pronounced than the changes in sperm concentration. This study shows the importance of genital heat stress as a cofactor in fertility impairment in men and indicates nocturnal scrotal cooling as a therapeutic option.
... Davidson (1945) stated, without elaboration, that over half of his patients had a disturbance of testis temperature regulation. Robinson & Rock (1967)Waites, 1970) and evaporation of a liquid (skin preparation) applied to the scrotum will alter temperature (Zorgniotti et al, 1980). Methods which measure emissivity of the skin by infrared thermometry and thermography reflect the temperature of the underlying testis (Comhaire, 1986). ...
Article
Intrascrotal temperatures were measured bilaterally by a non-invasive method in 300 subfertile men (mean sperm count 21.4 x 10(6)/ml) and 30 normospermic control men (mean sperm count 118.7 x 10(6)/ml). The subfertile men had mean (s.d.) temperatures of 34.7 degrees C (0.8) for the right and 34.8 degrees C (0.7) for the left testis. The value for both testes of the control men was 33.4 degrees C (0.6). The difference (1.3-1.4 degrees C) was significant (P = 0.03). An intrascrotal temperature of greater than 34.1 degrees C was found in greater than 83% of subfertile men, regardless of clinical diagnosis. This method can therefore be used to survey large numbers of men. We suggest that small intrinsic temperature increases may interfere with the ability of the testis to accommodate to environmental temperature stresses and so lead to abnormal semen and subfertility.
... Scrotal hyperthermia was shown to be associated with more or less severely impaired semen quality in men, including azoospermia, oligoasthenospermia, and teratozoospermia (6,14,(30)(31)(32)(33)(34)(35). Conversely, scrotal cooling improved sperm quantity and quality (36)(37)(38)(39). Warming of the testis has been proposed as a method of contraception (33,40). ...
Article
To evaluate methods of prevention of scrotal hyperthermia in laptop computer (LC) users. Experimental study. University hospital. Twenty-nine healthy male volunteers. Right and left scrotal temperature and LC and lap pad temperatures were recorded during three separate 60-minute sessions using a working LC in a laptop position: session 1, sitting with closely approximated legs; session 2, sitting with closely approximated legs with a lap pad below the working LC; and session 3, sitting with legs apart at a 70°angle with a lap pad below the working LC. Scrotal temperature elevation. Scrotal temperature increased significantly regardless of leg position or use of a lap pad. However, it was significantly lower in session 3 (1.41 °C ± 0.66 °C on the left and 1.47 °C ± 0.62 °C on the right) than in session 2 (2.18 °C ± 0.69 °C and 2.06 °C ± 0.72 °C) or session 1 (2.31 °C ± 0.96 °C and 2.56 °C ± 0.91 °C). A scrotal temperature elevation of 1 °C was reached at 11 minutes in session 1, 14 minutes in session 2, and 28 minutes in session 3. Sitting position with closely approximated legs is the major cause of scrotal hyperthermia. Scrotal shielding with a lap pad does not protect from scrotal temperature elevation. Prevention of scrotal hyperthermia in LC users presently is not feasible. However, scrotal hyperthermia may be reduced by a modified sitting position (legs apart) and significantly shorter use of LC.
... Heat has an adverse effect on spermatogenesis and it is believed that scrotal temperatures 1 to 2°C below body temperature would be a natural advantage to normal sperm morphology345. In a review of the literature, sperm count improved in 48% to 66% of the infertile men studied and six out of eight studies also showed an improvement in sperm motility, morphology or both with scrotal cooling, ranging from 28% to 83%56789101112. The increase in sperm count was noted as early as two weeks in oligospermic men after treatment initiation but a statistically significant increase in sperm count was noticeable from eight weeks onwards. The devices used to achieve testicular cooling were, however, not practical for day-to-day use. ...
Article
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Male infertility is a significant contributor to the need for fertility treatment. Treatment currently involves correcting any identifiable adverse lifestyle factors in men with suboptimal sperm parameters, and if these measures are unsuccessful, assisted conception is offered, which can be quite expensive. Raised scrotal temperature is one of the least studied but easily corrected risk factors for male infertility. In a recent review of the literature, sperm count, motility and morphology improved with scrotal cooling devices. The devices used to achieve testicular cooling were, however, not practical for day-to-day use. A potentially more practical device for scrotal cooling has recently been developed. The Babystart® FertilMate™ Scrotum Cooling Patch is a hydrogel pad which allows for comfortable application. The aims of this study were to investigate whether exposing the scrotum to lower temperatures by means of these new patches could improve semen parameters, thereby improving fertility, and to assess the feasibility of a clinical trial. This is a randomised controlled trial set in a university teaching hospital in the United Kingdom. The proposed sample size was 40 men with mild, moderate or severe oligoasthenospermia, of whom 20 would be randomised to wearing the scrotum cooling patch for 90 days and 20 men would be acting as controls and not wearing the patches. The primary outcome measure was the change in sperm concentration. Secondary outcome measures included the change in sperm volume, motility and morphology; endocrine parameters; metabolomic biomarkers; testicular volume and blood flow. Reasons for dropping out and non-compliance were also going to be noted and reported. The study started recruiting in October 2011 and as of November 2011 four men had been consented and were participating in the study. No operational challenges had been encountered at the time of the submission of this manuscript. Although the study also aimed to evaluate the feasibility of a definitive study, the change in sperm count after 90 days of wearing the scrotal cooling patches was made the primary outcome measure because a statistically significant improvement in sperm parameters with the scrotal patches would in itself be a definitive finding. Current Controlled Trials ISRCTN94041896.
... Sperm parameters improved in 64%-83% of men and pregnancy was achieved in 14%-50% of couples. [84][85][86][87] Discontinuance of hypothermia resulted in a return to pretreatment semen parameters. 85 The percentage of improved semen parameters was the same whether or not a varicocele was present. ...
Article
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While we may be comfortable with an allopathic approach to male infertility, we are also responsible for knowledge about lifestyle modifications and holistic, complementary, and alternative therapies that are used by many of our patients. This paper provides an evidence-based review separating fact from fiction for several of these therapies. There is sufficient literature to support weight reduction by diet and exercise, smoking cessation, and alcohol moderation. Supplements that have demonstrated positive effects on male fertility on small randomized controlled trial (RCT) include aescin, coenzyme Q 10 , glutathione, Korean red ginseng, L-carnitine, nigella sativa, omega-3, selenium, a combination of zinc and folate, and the Menevit antioxidant. There is no support for the use of Vitamin C, Vitamin E, or saffron. The data for Chinese herbal medications, acupuncture, mind-body practice, scrotal cooling, and faith-based healing are sparse or inconclusive.
Article
A relation between experimental elevation of testis temperature and poor semen has been known for over sixty years. Poor semen from elevated temperature due to intrinsic abnormality of testis thermoregulation has been a recent concept. A testicular hypothermia device (THD) was created which when worn by "hard core" infertile males with varicocele, failed varicocelectomy, or "subclinical" varicocele resulted in lowering of temperature with improvement in semen in many. Pregnancies have resulted. The device is noninvasive and well tolerated.
Article
Fifty-six males from infertile couples were categorised into two different groups and their semen quality examined. Patients in which there was no evidence of interference with normal testicular thermoregulation either during the day or the night were classified as 'cool workers' and 'cool sleepers' (Group I, n = 26). In the other group (II), 'warm workers'/'warm sleepers' (n = 30), there was evidence for scrotal insulation. The number of good moving spermatozoa per ejaculate as well as this number per ml was greater in 'cool workers'/'cool sleepers' than in 'warm workers'/'warm sleepers' (p less than 0.001). These results emphasize the need for comprehensive patient history when evaluating infertility problems. Similarly, living habits may play a role in human male infertility and treatment.
Article
Although the objective of this article was to discuss the specific medically treatable causes of male infertility, the reader will be impressed by the fact that many of the treatments seem less than "specific." The need to treat infections to improve fertility is ill defined. The utilization of a scrotal cooling device as "specific" nonsurgical treatment for varicocele is yet to be defined. Immunologic suppression is indeed a specific form of therapy for a measurable phenomenon; unfortunately, the significance of that phenomenon as well as the best means and location of its assessment are undergoing significant reevaluation. An exciting frontier is the prospect of preventing infertility in the patient undergoing therapy for cancer, thus obviating the need for treatment of the ensuing infertility. Before specific therapies can be anticipated to have a predictable beneficial effect, these areas require active investigation to define the problem more clearly.
Article
Evidence to support the contention that avoidance of testicular hyperthermia (due to hot baths and/or tight clothing) will improve fertility is, in the main, anecdotal. Semen samples derived from 128 infertile men were analyzed before and after a 3-month conservative treatment regimen. Six seminal characteristics were studied. Clinical evaluation included normal bath temperature, types of underwear worn, and past history of hernia repair, orchiopexy, or varicocelectomy. The patients were divided into three groups (A to C) according to sperm density and then subclassified on the basis of progressive motility status. The results show that a significant, or approaching significant, improvement in seminal characteristics occurs in certain groups of oligospermic individuals with pretreatment progressive motility of less than 40%. In clinical trials, it should be recognized that any improvement in seminal quality following pharmacologic or surgical intervention may include a contribution from conservative treatment.
Article
Three-quarters of 41 women whose husbands were the cause of infertility in the couple had one or more embryos replaced after in vitro fertilization. One-third became pregnant despite their long history of infertility; the incidence of pregnancy was 45% after one or more replacements of embryos. In a group of 61 couples where both partners were infertile, 26% became pregnant. These data indicate that the lower chance of fertilization with poor semen is balanced by a higher chance of pregnancy in women with a normally functioning reproductive system. Oligospermia, asthenospermia, teratospermia, and autoimmunity are among the many forms of male infertility which can now be successfully treated by in vitro fertilization. Overall, 57% of the oocytes were fertilized, and almost 50% of men with very low numbers of active spermatozoa (less than or equal to 0.5 X 10(6)/ml motile spermatozoa) were successful in establishing pregnancy. Two semen parameters impaired fertilization most: seminal inflammatory cells and low progressive activity. The collection of split ejaculates and the careful preparation of spermatozoa, by sedimentation and layering methods, proved to be beneficial, improving sperm motility and raising the chance of fertilization.
Article
Fifty men with oligospermia or reduced sperm motility were tested with scrotal cooling by ice packs applied to the scrotum at night and held in place with jockey shorts. Sperm density and motility were compared before and after treatment. At least a 2-fold increase in sperm density and comparable increases in sperm motility were seen in 65 per cent of the patients in this series. The percentage of successful treatment was the same whether or not a varicocele was present. These results further support the detrimental influence of heat on spermatogenesis.
Article
Mean scrotal surface temperatures overlying the testis clothed and unclothed reaffirm a prior observation that patients with very low spermatozoa counts (⩽ 20 mil./ml.) have higher temperatures than subjects with high spermatozoa counts (% 100 mil./ml.). The insulating effect of clothing results in mean temperature rises of 1.2 to 1.5°C. over the unclothed state regardless of semen status. There were no differences in temperature rise between wearers of “jockey” versus “boxer” undershorts.
Article
Two new techniques for measuring deep scrotal temperature are described. Paraplegic men in wheelchairs have deep scrotal temperatures averaging about 0.9 degrees C higher than normal sitting men, and those whose scrotal temperatures are very high usually lack motile spermatozoa. In the author, deep scrotal temperatures at constant air temperature are 0.5 degrees C lower wearing boxer shorts than wearing Y-fronts, and 1.2 degrees C lower wearing scrotal slit underpants than wearing boxer shorts; they are 1.6 degrees C lower sitting with thighs apart than sitting with thighs together, and 0.5 degrees C lower running than sitting with thighs apart. From such observations, means of lowering paraplegic deep scrotal temperatures can be designed.
Article
Chronic scrotal hypothermia to 25 patients with infertility and elevated testis temperature resulted in varying degrees of improvement over their pretreatment poor semen in 16/25. Pregnancy occurred in 6/25 "hard core" infertile couples (mean period of infertility 6.0 years) after wearing an evaporative scrotal cooling device for sixteen hours daily for a mean of 14.5 weeks. The offspring of such hypothermia-treated fathers appear to be normal. Varicocele, failed varicocelectomy, and "idiopathic infertility" are conditions suitable for such noninvasive hypothermic treatment. Discontinuance of hypothermia resulted in a return to pretreatment poor semen. Elevated temperature plays a role in poor semen.
Article
The author presents arguments which favor elevated temperature of the testis and adnexae as an important factor in patients with poor semen seen in varicocele and "idiopathic" infertility. This appears to be primarily the result of disturbed thermoregulation due to internal spermatic vein retrograde blood flow. Elevated testis temperature without varicocele may be present in as high as 54% of all patients with "idiopathic" infertility. The prevailing theory in the United States is that the varicocele's bilateral effect is due to a substance noxious to spermatogeneis which is carried to both testes by retrograde internal spermatic vein blood flow and via crossover to the contralateral testis. A review of the published evidence for the crossover does not confirm its presence in the deep circulation of the contralateral testis, but rather its restriction to the superficial contralateral scrotal venous drainage. A simpler explanation for the bilateral effect of varicocele on spermatogenesis and sperm maturation by the epididymis is a gradient to the contralateral testis from the affected testis which results in demonstrable elevated temperature in both.
Article
Elevation of testicular temperature may result in arrest of spermatogenesis, abnormal semen parameters and sterility. It has been proposed that brief style underwear may produce scrotal hyperthermia and lead to clinical subfertility. Although this idea is regarded as dogma by many in the lay community and the changing of underwear type is a therapy frequently recommended by medical practitioners, there is a paucity of data measuring scrotal temperature as a function of underwear type. Scrotal, core and skin temperatures were measured in 97 consecutive men presenting for evaluation of primary clinical subfertility. These cases were categorized by underwear type to boxer or brief group. Semen analyses were obtained in all patients. Individuals from each group were compared to ascertain differences in temperature when wearing and not wearing underwear. Baseline semen parameters also were compared. In 14 subjects (crossover group) underwear type was changed to the alternative type and scrotal temperature measurements were repeated. Literature regarding underwear type, testicular temperature and/or fertility was reviewed and critically analyzed. Mean scrotal temperature plus or minus standard deviation was 33.8 +/- 0.8 C and 33.6 +/- 1.1 C in the boxer and brief group, respectively. There were no significant temperature differences between the groups. Differential temperatures comparing core to scrotal temperature and semen parameters also were not significantly different. These observations remained constant in the crossover group. The hyperthermic effect of brief style underwear has been exaggerated. In our study there was no difference in scrotal temperature depending on underwear type. It is unlikely that underwear type has a significant effect on male fertility. Routinely advising infertility patients to wear boxer shorts cannot be supported by available scientific evidence.
Article
The testis is remarkable as a biologic system for its functional regulation by temperature. Not only does the testis function optimally at a relatively cool temperature, but core body temperature is lethal to germ cells. This temperature sensitivity has implications for clinical medicine, both in terms of understanding pathologic states and for therapeutic measures. Perhaps most important, the relationship between testis and temperature presents great opportunities for further elucidation of cellular control mechanisms, particularly with regard to gametogenesis.
Article
Fourteen young and sexually active patients with chronic abacterial prostatitis who failed to respond to conventional medical therapy underwent four 60 minute sessions of local prostatic hyperthermia. Calculated prostatic temperature was 42 +/- 0.5 degrees C. Analysis of seminal plasma was performed pre- and postoperatively and included: number, motility, and morphology of spermatozoa; zinc, citric acid, D-fructose, and free testosterone content. Preoperative semen analysis was normal in five patients and abnormal in nine. Morphodynamic and biochemical patterns of seminal plasma were not significantly altered by thermotherapy. Local prostatic hyperthermia can be safely used in patients with chronic abacterial prostatis not responding to conventional medical therapy and desiring to preserve their reproductive potential.
Article
The Testicular Hypothermia Device (THD) was conceived to test the theory that an intrinsic defect in testicular thermoregulation causes elevation of intrascrotal temperature and results in subfertile semen (Zorgniotti et al., 1980, 1986). When it was found that lowering temperature about 2.0°C by a prototype THD resulted in semen improvement and pregnancy in the wives of infertile men, the therapeutic potential was realized. The THD is a cotton scrotal covering which lowers temperature by controlled evaporation of water from its surface (Figure 1).
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هر چند رابطه احتمالی بین ناباروری مردان و اختلال های سیستمیک مثل مشکلات اونکولوژیک، بیماری های قلبی ـ عروقی، اختلال های متابولیک و بیماری های اتوایمیون همواره مد نظر متخصصان درمان ناباروری قرار داشته است، لیکن کاهش شانس باروری و حتی بروز ناباوری در مردان همواره نشــانه ای از آســیب به ســلامت عمومی ایشــان و نتیجه مواجه های غیرطبیعی با عوامل آلاینده زیســت محیطی و سبک زندگی ناسالم نیز بوده اســت به علاوه، دلایل ژنتیکی و مواجه های دوران جنینی مردان نابارور از طریق بندناف نیز به عنوان دلیل دیگری جهت بروز این اختلال جدی با پیامد آسیب عمومی به سلامت مردان مطرح گردیده است. اگرچه رویکرد مستقیم به استفاده از درمان های دارویی و غیردارویی در افزایش میزان باروری مردان مسیری معمول و جاافتاده در علم پزشکی است، نگرشی عمیق تر از زاویه نقش سموم در بروز این اختلال و نگاهی بنیادی به عوامل مرتبط با سبک زندگی از سویی در تعیین اتیولوژی و پیشگیری از بیماری حایز اهمیتی ویژه است. علاوه بر این که اســتفاده از طب مکمل نیز با تعدیل اثرات ســموم و آلاینده ها می تواند در کاهش آسیب به سلامت عمومی بیماران نابارور و تقویت کارآیی و اثر بخشــی روش های درمانی موجود و متداول مؤثر باشد. در این راستا، هدف از نگارش این مقاله، مروری اجمالی و مبتنی بر شواهد در خصوص سبک زندگی و افزایش خطر ناباروری مردان از یک ســوی و ارزیابی اثربخشی درمان های مکمل و نوین از سوی دیگر است. در واقع، این مقاله مروری است به نقش سبک زندگی مثل کاهش وزن با رژیم و ورزش، ترک ســیگار، کاهش مصرف الکل و تغذیه از یک سوی و نقش مصرف مکمل های گیاهی از جمله ،2 ، کیوتن، گلوتاتیون، جین ســینگ قرمز، ال کارنیتین، سیاه دانه 1 مکمل های حاوی شــاه بلوط (آزین) ، ســلنیوم، زینک ـ فولات ـ آنتی اکســیدان ها در افزایش میزان باوری مردان نابارور از سوی 3امگا ، زعفران، E، ویتامین C دیگر. در ادامه در این مقاله اطلاعات موجود در خصوص کاربرد های ویتامین معنویت درمانی، هنردرمانی و موسیقی درمانی را نیز خواهید خواند.
Article
We studied the use of a testicular hypothermia device worn daily for at least 16 weeks in 64 men with subfertile semen and elevated testicular temperature, who had had an infertile marriage for 2 or more years in which the wife was judged fertile. Improvement in 1 or more semen parameters was seen in 42 patients (65.6 per cent). Semen analysis was converted into the motile oval index, a numerical value representing the count, motility and normal morphology. The motile oval index helps to predict pregnancy outcome. Of 21 patients with pre-treatment motile oval indexes greater than 4.8 million per ml. 11 (52.4 per cent) produced pregnancy. Patients with lower starting indexes did not fare as well. Of 20 patients who met the criteria, and who wore the device for less than 2 weeks or not at all and had no other treatment 1 (5.0 per cent) produced pregnancy. Mean hypothermia time to date of missed menses was 4.2 months. Six patients with nonobstructive azoospermia showed no semen change with the testicular hypothermia device.
Chapter
The late Mr Selby Tulloch, formerly senior urologist at the Western General Hospital, Edinburgh, reported restoration of sperm output in an azoospermic man following varicocele ligation (Tulloch 1952). This report helped in the worldwide acceptance of the role of varicocele in male infertility and in recognition of this was republished in the classical urological papers section of the journal Urology (Tulloch 1984). Varicocele ligation or occlusion has become one of the most frequently offered treatments for male infertility. There has been a search for subclinical varicocele and a move to recommend treatment at an earlier age. However, in a publication of a retrospective series from Australia the following statement was made at the end of the discussion: “Our results strongly suggest that testicular vein ligation is not effective in increasing fertility and confirms other reports that doubt the value of treatment of varicoceles in infertile men (Rodriguez-Rigau et al. 1978a; Nilsson et al. 1979, Vermeulen and Vandeweghe 1984). Onus is now on the proponents of the treatment … to prove their case” (Baker et al 1985). Furthermore in a series of 9034 men investigated according to a World Health Organization standard protocol spontaneous pregnancies were as frequent in couples in whom the men did or did not have varicocele (WHO 1992).
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In the general population, approximately 15% of couples intending to have children are found to be infertile. In about 30–50% of these couples, the male partner is either totally or partially responsible for the infertility (22). From these satistics, it appears that between 5 and 7% of males intending to impregnate their spouses are infertile.
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Klassischerweise tritt das Problem der retrograden Ejakulation bei Hodentumorpatienten als Folge einer retroperitonealen Lymphonodulektomie aufgrund einer Grenzstrangverletzung auf. Seltener ist das Problem bei Patienten, bei denen eine transurethrale Resektion der Prostata beispielsweise wegen einer chronischen Prostatitis erfolgte und die häufig den Verlust der koordinierten Verschlußfunktion des Blasenhalses bedingt. Weitere Ursachen sind in Tabelle 12.1 aufgeführt. Darüber hinaus können Medikamente durch eine ganglionäre oder adrenerge Blockade die Emission bzw. Ejakulation beeinträchtigen (s. Tabelle 12.2).
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Die Urgeschlechtszellen sind bereits bei einem Embryo mit einer Sch?delstei?l?nge (SSL) von 2?3 mm nachweisbar. Sie entstehen etwa in der 3. Woche der Fetalentwicklung und befinden sich in der Wand des Dottersackes nahe der Ansatzstelle des Allantois-Ganges. Die Gonadenanlage aus Rinde und Mark ist bei beiden Geschlechtern zun?chst gleich, d.h. indifferent und bisexuell. Sie enth?lt noch keine Keimzellen. Die am?boid-beweglichen Geschlechtszellen bilden Pseudopodien und wandern vom Ektoderm des Dottersakkes sp?ter in die Verdickung des Z?lomepithels, die Keimleiste, ein, die sich durch eine Furchenbildung von der Urnierenfalte abgrenzt. Bei der Wanderung der Urgeschlechtszellen (Keimzellmigration), die z.T. auch ?ber die Gef??e erfolgt, spielt offenbar eine positive Chemotaxis eine Rolle. Die Gonadenanlage wird bei einem 4?5 mm gro?en Embryo (SSL) nachweisbar.
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Interestingly enough, the earliest references to alteration of the testis have to do with varicocele. Celsus (Born ca. 25 AD) spoke of cirsocele (varicocele): “When the disease has spread also over the testicle and its cord, the testicle sinks a little lower and becomes smaller than its fellow inasmuch as its nutrition has become defective.”
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Testicular temperature is reflected by the temperature of the overlying scrotum. The scrotum is well placed anatomically and is capable of physiologically maintaining a hypothermic testis. However, when normal thermoregulation of the testis is impaired, heat stress can occur, negatively effecting semen quality and sperm concentration, motility, and morphology. A number of factors can disturb thermoregulation and increase testicular temperature including pathological conditions such as varicocele and cryptorchidism, posture, clothing, common lifestyle choices such as use of saunas and warm baths, certain exercises such as cycling, laptop usage and occupations that involve or generate heat, and raised ambient temperature. Often, these factors do not occur alone but in combination with one another, which compounds the negative effect of high testicular heat levels on semen parameters. This chapter discusses physiological thermoregulation in the testis, the impact of its failure on semen quality and enumerates factors that could simultaneously and cumulatively contribute to testicular heat stress. Awareness of the potential risks involved and methods to alleviate prolonged scrotal warming are important in the preservation of male fertility. Simple changes to daily habits could help lessen the impact of increased testicular temperatures on male fertility.
Article
Two clinically tolerable methods of producing testicular hypothermia have been studied in dogs. Evaporative cooling produced a 3.7 degree fall and ice water a 9.7 degree fall in intratesticular temperatures. Scrotal skin blood flow (mls/100 gm/min) fell from 4.9 ± 4.6 to 2.3 ± 1.2 and 1.3 ± .05 with the two techniques and was associated with increased vascular resistance. In contrast, no significant change was noted in testicular blood flow. These data show that testicular blood flow cannot be altered by clinically tolerable hypothermia.
Article
The aim of this study was to systematically review the evidence for the impact of scrotal cooling on spermatogenesis. EMBASE (1980-2010) and MEDLINE (1950-Sept. 2010) databases were searched using the terms 'male infertility or subfertility or fertility', combined with a separate search of 'scrotal cooling', without any limits or restrictions. A total of eight articles met the criteria for inclusion in the study. There was insufficient evidence to draw any firm conclusions about the impact of scrotal cooling on male fertility. A positive trend of improved male fertility was however observed. There is therefore a need for well designed randomised controlled trials.
Article
Varicoceles are a treatable cause of male infertility, but very clinically diverse. Both histologic and molecular changes occur in the testes of men with varicocele. Physical measurements (scrotal temperature, testicular volume, pressure within the pampiniform plexus, basal lamina thickness) correlate with prognosis, but these correlations have not been accepted as predictors of successful repair because of variation within patient populations. Conventional semen parameters similarly correlate, but these correlations apply only to men with >5 x106 sperm/ejaculate. Levels of toxicants (e.g. norepinephrine, cadmium), reactive oxygen species byproducts, and hormones, their receptors and modulators have been evaluated as predictors in small-scale studies. Medical therapies (antoxidants, anti-inflammatories and hormones) have been applied empirically to small groups of patients with positive results that have not been verified in large-scale trials. Thus, urologists still face a challenge to determine which patients will benefit from varicocelectomies and/or medical interventions. In this review we summarize our current understanding of the pathophysiology of varicoceles, and discuss some of the new findings that may be applicable to specific clinical situations.
Article
Poor spermatogenesis in patients with inflammation of the genital tract is associated with scrotal hyperthermia. These patients can benefit from acupuncture treatment. We conducted a study to verify whether the influence of acupuncture treatment on sperm output in patients with low sperm density is associated with a decrease in scrotal temperature. The experimental group included 39 men who were referred for acupuncture owing to low sperm output. The control group, which comprised 18 normal fertile men, was used to define a threshold (30.5 degrees C) above which scrotal skin temperature was considered to be high. Accordingly, 34 of the 39 participants in the experimental group initially had high scrotal skin temperature; the other five had normal values. Scrotal skin temperature and sperm concentration were measured before and after acupuncture treatment. The five patients with initially normal scrotal temperatures were not affected by the acupuncture treatment. Following treatment, 17 of the 34 patients with hyperthermia, all of whom had genital tract inflammation, had normal scrotal skin temperature; in 15 of these 17 patients, sperm count was increased. In the remaining 17 men with scrotal hyperthermia, neither scrotal skin temperature nor sperm concentration was affected by the treatment. About 90% of the latter patients suffered from high gonadotropins or mixed etiological factors. Low sperm count in patients with inflammation of the genital tract seems to be associated with scrotal hyperthermia, and, consequently, acupuncture treatment is recommended for these men.
Article
A key factor in testis temperature investigation is thermometry. The insertion of thermocouples and thermistors into the substance of the testis or into the scrotum goes back to the 1920’s. As this is invasive, large scale studies are difficult owing to refusal on the part of volunteers and even patients to participate. Thermistors are also not ideal for reasons which affect the accuracy of readings: e.g., use of anaesthesia (Waites, 1970), evaporation of liquid applied to the scrotum (skin preparation) (Zorgniotti et al., 1980), and temperature may vary with depth of placement since we know that temperature is higher at the mediastinum testis than peripherally.
Article
For infertile men with a history of testicular maldescent only few therapeutic options exist beside assisted reproduction. The aim of our study was to evaluate the influence of nocturnal scrotal cooling on semen quality in such patients presenting with oligozoospermia. Twenty infertile men with a history of testicular maldescent and oligozoospermia were included for nocturnal scrotal cooling over 12 weeks for every night. To increase nocturnal periscrotal air circulation we used a membrane pump connected via plastic tubes to receptacles placed in both groins. Semen analysis was performed at the beginning of the cooling period and at weeks 4, 8 and 12. Another 20 infertile patients with a history of testicular maldescent and oligozoospermia were followed without specific treatment and served as a retrospectively built control group. Scrotal cooling at night by means of a perigenital air stream resulted in a scrotal temperature drop by 0.8 degrees C (median). A significant increase in sperm concentration and total sperm count was achieved by nocturnal cooling after 8 weeks (p < 0.01; p < 0.05; respectively) and 12 weeks (p < 0.01; p < 0.01; respectively). The improvement of sperm motility and sperm morphology was statistically insignificant. The present study suggests nocturnal scrotal cooling as a therapeutic option to improve semen quality. In a further controlled prospective study the influence on pregnancy rates should be evaluated.
Article
Alterations of intrascrotal temperature markedly affect spermatogenesis and sperm counts. In euspermic subjects, scrotal exposure for 30 minutes to a 150-watt electric light bulb resulted in reversal of the scrotal-rectal temperature ratio by a mean of 2.9 C. Such treatment on 14 consecutive days caused depression of spermatogenesis followed by rebounds to temporarily high sperm counts. Application of an ice bag to the scrotum for a mean of about 30 minutes cooled the testicular environment by a mean of 6.9 C. Such cold treatment on 14 consecutive days, beginning not less than 12 days following cessation of exposure to heat, stimulated spermatogenesis without initial inhibition, nearly trebling the mean pretreatment count. Oligospermic subjects responded to both heating and cooling faster and to a relatively greater degree, but less predictably, than did euspermics. The greatest increase in spermatogenesis followed sequential application of heat and cold, which suggested possible therapeusis in oligospermia.
Article
Indirect methods for measuring testicular temperatures probably give valid results. A change in position from supine to standing resulted in a drop of 0.6° C. in intrascrotal temperature. There was no difference in right versus left intrascrotal temperatures except in standing varicocele subjects, in whom the left intrascrotal temperature was significantly higher (0.3° C.). There was a significantly higher intrascrotal temperature (0.6-0.8° C.) in infertile subjects with varicocele than in a control group. Temperature comparisons between infertile subjects without varicocele and a control group did not yield significant results. A distribution curve of intrascrotal temperatures in infertile subjects without varicocele was bimodal, suggesting the presence of a nonhomogeneous population within this group. There was a relationship between decreased testicular size and deranged morphology and increased intrascrotal temperatures in the subjects studied. Tympanic membrane temperatures appeared to be higher in variococele patients than in a control group.
Control of human spermatogenesis by in-duced changes of intrascrotal temperature
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