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Query: UMLS:C0021359 (infertility)
 26,075 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hyperprolactinemia is frequent in clinical endocrinology. Its commonest causes are, besides pregnancy and lactation, drugs, mainly involving the generally used psychopharmaca and the equally ubiquitously prescribed estrogens. The single most important cause is a pituitary tumor, the prolactinoma, but lesions of the hypothalamus or pituitary stalk, primary hypothyroidism, liver cirrhosis and chronic renal failure, among others, may also provoke hyperprolactinemia. The clinical features of hyperprolactinemia in women are mainly amenorrhea, or irregular menses, galactorrhea, hirsutism, infertility and loss of libido. In men loss of libido and/or impotence are the most important symptoms, accompanied by infertility. Macroadenoma, more frequently seen in men than in women, may cause tumor symptoms such as headache and ophthalmologic disorders (visual field loss). The main biochemical finding is hyperprolactinemia, which should be repeatedly checked. In general, high concentrations are mainly found in large adenomas, while microadenomas usually involve only mild hyperprolactinemia, though there are numerous exceptions. While dynamic tests of prolactin secretion have provided useful information about the pathophysiology of prolactin secretion, their use in routine clinical work is controversial and of limited value. As a routine neuroradiological examination, high resolution CT of the pituitary area is to be recommended. In all hyperprolactinemic patients with suspicion of macroadenoma, ophthalmologic evaluation of fundus and visual fields should be performed. Dopaminergic drugs such as bromocriptine rapidly reduce serum prolactin levels in hyperprolactinemic women and men with micro- or macroadenoma. With these drugs considerable tumor shrinkage is possible.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Hyperprolactinemia]. 395 83

The introduction of radioimmunoassay for prolactin concentrated interest in infertility research on prolactin-producing pituitary adenomas (prolactinomas). In women in the fertile age group these tumors cause amenorrhea and galactorrhea, and in men loss of libido, impotence and occasionally gynecomastia. Microprolactinomas (diameter 10 mm and less) and macroprolactinomas (diameter more than 10 mm) differ in growth characteristics, symptomatology and prognosis. Different therapeutic approaches may be used. Both bromocriptine treatment and selective microsurgical tumor extirpation are successful. Both have advantages and disadvantages, thus rendering the decision as to appropriate treatment increasingly difficult. Recent findings demonstrate that bromocriptine may cause irreversible tumor fibrosis, which decreases the chances of prolactin normalization by subsequent surgery.
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PMID:[Prolactin producing hypophyseal adenoma: diagnosis and therapeutic possibilities]. 402 73

The diagnostic value of measurements of plasma and urinary luteinizing hormone (LH) has been studied in 209 patients with endocrine disease. In 44 patients puberty was either delayed or had failed to occur. In those with chromosomal abnormalities the LH levels were often within the normal range, whereas those with a pituitary cause usually had low levels. In boys with delayed puberty plasma LH levels rose before physical changes occurred and had prognostic value. In patients with later gonadal failure, men with impotence or infertility, and women with secondary amenorrhoea LH assays proved of little value, although in one case a premature menopause was suspected and six patients with anorexia nervosa had low LH levels.Sixty patients with disorders of the hypothalamicpituitary area were studied. Levels of LH were measured and considered in relation to the other anterior pituitary hormones. Impairment of LH secretion was one of the first effects on hormone production of disease affecting this area, and this was, of course, most readily detected in postmenopausal women.The normal ranges of both plasma and urine LH are wide and there seems to be considerable day-to-day variation, especially of urinary output. Several samples should, therefore, be measured if therapeutic decisions are involved.
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PMID:Plasma and urinary luteinizing hormone levels in the diagnosis of endocrine disease. 501 51

Pituitary regulation of gonadal function was investigated in 39 consecutive men with treated and untreated coeliac disease and in an intestinal disease control group of 19 men with Crohn's disease of similar age and general nutritional status. Basal serum FSH concentration was increased in 10 of the coeliacs (26%) compared to only two of 19 men with Crohn's disease (11%). This abnormality was observed with equal frequency in both treated and untreated coeliacs, and was not associated with oligospermia. Serum LH concentration was increased in eight of 15 untreated coeliacs (53%) with sub-total villous atrophy, an abnormality which unlike the elevation of serum FSH, appears to return towards normal after gluten withdrawal. Serum LH was high in coeliacs despite marked elevation of the free testosterone index. Exaggerated responses of FSH and LH to LHRH were found in 89% and 45% respectively, of coeliacs with sub-total villous atrophy. However, exaggerated responses of LH alone were found more frequently in coeliacs than in men with Crohn's disease (P less than 0.02) and unlike the exaggerated FSH responses, LH responses were closely related to jejunal morphology. Exaggerated responses of FSH and LH in coeliacs were commonly found when basal gonadotrophin concentrations were normal. The occurrence of exaggerated gonadotrophin responses could not be related to plasma concentration of testosterone, dihydrotestosterone, oestradiol or the free testosterone index. Serum prolactin was modestly raised in 25% of untreated and partially treated coeliacs and in the same proportion of men with Crohn's disease. Elevated serum prolactin concentrations never exceeded 809 mU/l and were not associated with impotence or infertility. This study provides further evidence that in men with coeliac disease there is a derangement of pituitary regulation of gonadal function. This would seem to be part of a wider disturbance of central regulatory mechanisms of endocrine function in coeliac disease.
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PMID:Male gonadal function in coeliac disease: III. Pituitary regulation. 641 18

Since 1974, 900 patients with erectile dysfunction from various causes underwent implantation of a semi-flexible prosthesis, generally of the Small-Carrion type. The largest group had arteriosclerotic or hypertensive cardiovascular disease. The second largest group was composed of patients with diabetes mellitus. Those in the third group had undergone prostatectomy, cystectomy, or abdominal-perineal resection. For a large number of patients a diagnosis of psychogenic impotence was reached, mainly from the results of the history questionnaire and the Minnesota Multiphasic Personality Inventory. Complications were rare (8.1%). Preoperative, intraoperative, and postoperative considerations include correct selection of prosthesis, rigorous antibiotic coverage, prevention or care of perforation, and possible need for reoperation. The results were almost uniformly successful. Psychogenic cases and instances of infertility related to the impotence are reviewed.
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PMID:Surgical treatment of impotence with Small-Carrion prosthesis. Preoperative, intraoperative, and postoperative considerations. 671 88

Sexual dysfunction in end-stage renal disease is a troublesome, multifactorial disorder. Abnormality of the hypothalamo-pituitary-gonadal axis is but one of the causes leading to the impotence and infertility commonly encountered in chronic renal failure. Short of kidney transplantation, no therapy is available. Though infertility is the rule in end-stage renal disease, successful fatherhood and deliveries have occurred on rare occasions.
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PMID:Sexual dysfunction in chronic renal failure. 677 75

Various kinds of treatments of testicular cancer results in significant changes in peptide hormones, particularly LH and FSH. In some cases, compensated hypothyroidism as indicated by increased TSH with normal T3 are observed. Serum levels of prostaglandin F2 alpha are also elevated after therapy without relation to the stage of the disease. During followup, these patients are found to complain of impotence and infertility, and the evaluation of serum analysis of peptide hormones must consider both the normal hormonal findings of treated testicular cancer patients and recurrence of endocrine active tumor. The hormonal changes from hypophyseal origin are secondary to the primary testicular damages in patients complaining of impotence without tumor recurrence.
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PMID:LH, FSH, TSH, prolactin, HCG and prostaglandin F2 alpha in patients with treated testis tumors. 678 77

The purpose of this study was to determine whether routine prolactin measurement was of use when investigating men with infertility. Prolactin levels were slightly higher in men with primary infertility, compared with men with secondary infertility and a fertile control group. Although this slight increase was statistically significant, most readings were within the laboratory normal range in all groups, and we did not find any clinically significant cases of hyperprolactinemia. We conclude that routine prolactin estimation is not justified unless there are other indications, e.g., impotence, dialysis, or a history of previous pituitary disease.
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PMID:Searching for the infertile man with hyperprolactinemia. 679 40

On 17 male patients with infertility and 13 with impotence hormonal changes in the hypothalamus-hypophyse-testiculary system have been investigated by radioimmunoassay. On patients with infertility low plasmatestosteron and increased LH and FSH levels were found. 2.5 to 3 fold increase of plasmatestosteron levels were found on patients with impotence.
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PMID:[The significance of dyshormonal changes in the hypothalamo-hypophyseal-gonadal system in the diagnosis of infertility and impotence in the male]. 681 36

Vasectomy is a rapid, inexpensive, 1-time method of birth control that has been chosen by 50 million men, 3/4 of whom live in the US, India, and South Korea. Although the operation has found little favor in Mediterranean countries, it is gaining interest in some countries of Latin America and the Middle East. Vasectomy can be performed on an ambulatory basis using local anesthesia and is associated with a very low rate of morbidity and almost no mortality. At present it is reversible in only about 25-35% of cases. A dialogue between the urologist and the patient is of the utmost importance to rule out any possible medical contraindication and to insure that the patient understands the permanence of the procedure and has chosen it voluntarily. The rate of complications of all types in different series varies from 1-122/1000 operations, with hematoma, infection, and epididymitis the most common. Spontaneous reanastomosis occurs in .1-.3% of cases. Some studies have minimized the probability of negative psychosocial consequences such as impotence or loss of libido resulting from the operation, stating that many couples have improved sexual relationships and that fewer than 1% of men express regret at not being able to father additional children, while other studies suggest more widespread reactions of insomnia, depression, hypochondriacal troubles, or sexual symptoms. Negative reactions occur most frequently in men who have not been adequately prepared psychologically for the procedure. Several prospective studies in men undergoing vasectomy have failed to demonstrate changes in testicular volume or in histologic status of the testicular parenchyma several years after operation, although changes at the epididymal level may occur. Although no absolute proof exists, it is likely that the presence of antisperm antibodies in the serum or seminal fluid after vasectomy plays a role in the persistent infertility of men undergoing sterilization reversal operations. The immunological effect of vasectomy on other organs and systems is a subject of controversy. The possible relationship between vasectomy and atherosclerotic disease also remains to be elucidated.
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PMID:[Vasectomy. Advantages, complications and consequences]. 685 68


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