男性不妊の研究 第IV篇: 治療

Abstract

A total of 201 patients with male sterility were treated at o ur clinic during past 6 years. 1. Surgery to repair an impatency of the vasa or epididymes was indicated f o r 22 patients with obstructive azoospermia ; in 6 of these vaso-vasostomies were performed ; in 6, vaso-epididymostomies ; in 8, vaso-orchidostomies ; in 2, vaso-epididymostomy and vasoorchidostomy. Of the 22 azoospermic patients operated on, 9 (40.9 per cent) delivered postoperatively the semens containing motile spermatozoa and 2 (9.1 per cent) of these followed by conceptions. 2. Androgens, both androgens and gonadotropins or both androgens and estrogens were used for 28 patients with azoospermia and 32 patients with oligozoospermia. Of the 28 azoospermic patients, 2 (7.1 per cent) showed a significant increase in sperm concentration after the therapy. Of the 32 oligozoospermic patients, 15 (46.9 per cent) showed a significent increase in sperm concentration and 11 (34.3 per cent) in sperm motility after the therapy. There were, however, no conceptions obtained. 3. Thyroid therapy with L-Triiod o thyronine was applied to 10 patients with azoospermia and 29 patients with oligozoospermia. Of the 10 azoospermic patients, only 1 (10 per cent) showed a significant increase in sperm concentration after the therapy. Of the 29 oligozoospermic patients, 20 (68.9 per cent) showed a significant increase in sperm concentration and 6 (20.7 per cent) in sperm motility after the therapy, and 2 of these followed by conceptions. 4. Both L-Triiodothyronine and gonadotropin were used for 10 patients with azoospermia and 30 patients with oligozoospermia. No significant therapeutic effects were observed amongst the azoospermic group. Of the 30 oligozoospermic patients treated, 18 (60 per cent) showed a significant increase in sperm concentration and 15 (50 per cent) in sperm motility, and 2 of these followed by conceptions. 5. AICA orota t e , a precursor of nuclear acids, was administered to 8 azoospermic arid 14 oligozoospermic patients. There were no significant effects upon the azoospermic group. Of the 14 patients with oligozoospermia, 8 (57.1 per cent) showed a significant increase in sperm concentration and 5 (35.7 per cent) in sperm motility after the therapy. None of these, however, followed by conception. 6. Both AICA orotate an d gonadotropin were used for 7 patients with oligozoospermia , of which 5 (71.4 per cent) showed a significant increase in sperm concentration and 3 (42 .9 per cent) in sperm motility after the therapy. One conception occured. 7. Vitamin E therapy was applied to 4 patients with oligoz o ospermia , of which 3 (75.0 per cent) showed a significant increase in sperm motility after the therapy. No influences upon the sperm concentration were observed. 8. Varicocelectomy was performe d in 2 patients with oligozoospermia in which the varicocele was considered to be responsible for the reduced spermatogenesis. Both patients followed by conceptions within a couple of years after the surgery. 9. 5 patients with male sterility probably due to var i o us disorders of the siminal vesicules or ejaculatory ducts were treated surgically or medically. Of a total of 5 patients treated, 4 (80 per cent) exhibited an improvement in the previously abnormal semen, and 2 of these followed by conceptions. The incidence of t h e conceptions following the various therapies for the above mentioned series was 11 cases in all, 5.5 per cent of a total of 201.cases.