Clinical implications of measuring prolactin levels in males of infertile couples

Abstract

SUMMARYAlthough in females of infertile couples abnormal prolactin (PRL) has a definitive role in the medical flowchart, its role in males is less clear. Animal models suggest that PRL does not play a major role in male reproduction, although its trophic action on male accessory glands was often observed. Studies in humans are scanty. We systematically evaluated possible clinical and ultrasound correlates of PRL in males of infertile couples. Of 288 consecutive males of infertile couples, 269 (36.6 AE 4.4 years) without genetic abnormalities were studied. All men underwent physical, biochemical, seminal evaluation and scrotal and transrectal ultrasound before and after ejaculation. Ejaculatory and erectile functions were assessed by Premature Ejaculation Diagnostic Tool (PEDT) and International Index of Erectile Function (IIEF)-15 respectively; prostate-related symptoms by National Institutes of HealthChronic Prostatitis Symptom Index and International Prostate Symptom Score; psychological symptoms by Middlesex Hospital Questionnaire. Among semen parameters, only the positive association between PRL and ejaculate volume was significant, even adjusting for age, total testosterone and thyroid-stimulating hormone (adj. r = 0.126, p < 0.05). In a logistic ordinal model, adjusting for the aforementioned confounders and ejaculate volume, PRL was negatively associated with delaying ejaculation according to PEDT#1 score (Wald = 4.65, p < 0.05). In an age-and ejaculate volume-adjusted, iterative binary logistic model, low PRL was associated with a fivefold risk of any failure in controlling ejaculation , p < 0.05). Among scrotal and transrectal ultrasound features, we found a significant positive association between PRL and seminal vesicles (SV) volume and inhomogeneity, before and after ejaculation, and with deferential ampullas diameter. Associations with PRL were confirmed in nested 1 : 1 case-control analysis. No significant associations were found between PRL and other clinical parameters. For the first time, this study extends the concept of a trophic effect of PRL on male accessory glands from animals to humans. We report a positive association among PRL and ejaculate and SV volume, before and after ejaculation. Low PRL is associated with a lessened ability to control ejaculation.

Diagnosis of Partial Retrograde Ejaculation in Non-Azoospermic Infertile Men with Low Semen Volume

“…Such a stasis in the posterior ureter could result either from an “ejaculation dyssynergia” due to a lack of coordination between bladder neck and external sphincter [25]; or from a hormonal disturbance. Indeed, comparisons between subjects with prolactin (PRL) < 140 mU/L (139 case patients) and age-, total testosterone-, TSH-matched controls (n = 139; PRL > 140 mU/L) showed that subjects with reduced PRL had more often lower ejaculate volume, less seminal vesicle total volume either before or after ejaculation, a lower mean deferential ampullas diameter [26]. Moreover, a low PRL was associated with a weaker ability to control the ejaculatory reflex [26].…”

Protective Effects of Pleurotus tuber-regium on Carbon- Tetrachloride Induced Testicular Injury in Sprague Dawley Rats

“…Chen et al (2005) explained that Clonorchis sinensis activated both PKA and PKC signal transduction pathways to stimulate cell steroidogenesis. Although there seem to be no significant association between semen parameters and prolactin levels (Lotti et al, 2013), prolactin can affect steroidogenesis by modulating the expression of LH receptors (Dombrowicz et al, 1992), or by regulating the activity of steroidogenetic enzymes (Chandrashekar and Bartke, 1988) and has a trophic effect on male seminal accessory glands.…”

The characterization, current medications, and promising therapeutics targets for premature ejaculation

“…However, in recent study prolactin on male accessory glands from animals to humans had trophic effect and a positive association among prolactin and ejaculate and seminal vesicles volume, before and after ejaculation was observed (Lotti et al, 2013). It was suggested that low prolactin is associated with a lessened ability to control ejaculation (Lotti et al, 2013). Men with prolactin levels at the lowest quartile are at increased risk of developing the metabolic syndrome, arteriogenic ED, PE, and associated anxiety symptoms ).…”

“…Hyperthyroidism enhances SHBG, which binds androgens with higher affinity than estrogens resulting in hyperestrogenism (Carani et al, 2005). However, in recent study prolactin on male accessory glands from animals to humans had trophic effect and a positive association among prolactin and ejaculate and seminal vesicles volume, before and after ejaculation was observed (Lotti et al, 2013). It was suggested that low prolactin is associated with a lessened ability to control ejaculation (Lotti et al, 2013).…”