Testicular biopsy specimens from 11 infertile men were incubated in vitro with [3H]progesterone before and during long term gonadotrophic treatment. The main metabolites along the delta-4 metabolic pathway and 20 alpha-dihydro-progesterone were determined and the ratio between 20 alpha-dihydro-progesterone and 17 alpha-hydroxyprogesterone formed in vitro was calculated. In 5 patients with originally high ratios (indicating gonadotrophic understimulation), steroid metabolism changed significantly towards a more stimulated pattern. Three of these patients also showed a significant increase in sperm output and 2 of them fathered children. In 6 patients with an originally low ratio (indicating adequate gonadotrophic stimulation) no change in steroid metabolism in vitro or spermatogenesis was seen during therapy. Thus, this ratio between formed 20 alpha-dihydro-progesterone and 17 alpha-hydroxyprogesterone in vitro seems to be of value in predicting whether gonadotrophic treatment will be of clinical benefit.
Oestrogens administered to adult males are known to suppress the synthesis of androgens in the testicles. A main effect of this treatment on testicular steroid metabolism in vitro seems to be a significant reduction of 17α‐hydroxylase activity. A concomitant increase in the 20α‐hydroxysteroid dehydrogenase activity was, however, observed in four young oestrogen‐treated transsexual males (Rodriques et al. 1976).
We have analysed the metabolism of [3H]progesterone in vitro in testicular tissue incubates derived from six males on current oestrogen treatment and from one male 19 weeks after cessation of oestrogen therapy.
The metabolism in general of [3H]progesterone in vitro was observed to be decreased in all males on oestrogen treatment as compared to control subjects. The metabolite 20α‐dihydroprogesterone was found to constitute between 85–91 per cent of all metabolites formed in the patients under treatment.
On the contrary, the metabolic pattern observed in the previously treated male, appeared to be fully consistent with the patterns observed in non‐treated control subjects. Thus, the main alterations in intratesticular progesterone‐metabolism caused by exogenous administration of oestrogens, at least for 23 consecutive weeks, seem to be completely reversible.
The in vitro conversion of tritiated pregnenolone and progesterone was studied in testicular tissue from three infertile adult males before and during 25-30 weeks of theapy with hCG alone or combined with hMG. Furthermore, the in vitro conversion of pregnenolone was studied in testicular tissue from five prepubertal boys with undescended testes, two of whom had been subjected to hCG treatment for 5 weeks. The gonadotrophic treatment appeared to augment the steroid conversion mediated by the enzymes 30-hydroxysteroid dehydrogenase and 17a-hydroxylase in adult as well as prepubertal testicular tissue. The coversion mediated by C17-20-lyase along the A4 metabolic pathway was not increased, causing a "trap" along the A4 metabolic pathway. The increased production of testosterone in vitro from tritiated pregnenolone, which was observed during gonadotrophic treatment, probably took place along the A5 metabolic pathway through the C17-20-lyase step, whereas C21 steroids converted to the A 4 metabolic pathway were found to be "trapped" as 17a-hydroxyprogesterone.
At the level of first contact, a primary health care centre, information management is an unwieldy task, therefore health information systems are reported to be inadequate and weak. Microcomputers could improve information management at this level, but there is little success due to a lack of specialized application software. In this paper we describe software developed after a multi-centre systems analysis study, on an essential data set, to support the delivery of the public health programmes for family welfare, i.e. maternal health care, family planning and immunization programmes. The modular approach was taken to develop a common application software for information management use at multiple sites. The software is tested in a laboratory mode by retrospective data entry from sites in Sweden and in India. All the information could be entered and site-specific reports that were generated are compared. The software provided a common data collection format, an essential platform for outcomes research.
In an infertile man with azoospermia and arrest at the spermatogonial stage, hCG treatment alone improved the spermatogenesis but not beyond the primary spermatocyte stage. During hCG treatment steroid conversion in vitro in testicular biopsy material, as well as serum testosterone concentrations increased dramatically. When hMG treatment was added, spermatogenesis was complete. Combined hCG/hMG treatment seems to be an efficient therapy in well-selected infertile men, whereas increased testosterone production induced by hCG-treatment may be insufficient for restitution of spermatogenesis.
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