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男子不妊症

대한의학협회지 1973년 16권 1호 p.47 ~ 62
李熙永,
소속 상세정보
李熙永 (  ) 
서울대학교 의과대학 비뇨기과학교실

Abstract


This clinical study has been undertaken to find out the most effective medical treatment for 275 cases of spermatogenic disturbances for the period of 7years between 1965 and 1971. The follosanb data are preyent as abstraction of clinical usefulness of various drugs on oligospermias and azoospermias.
1. The subjects are composed of 141 cases of oligospermias(sperm counts per m1. are less than 40 million) and 134 cases of azoospermias(30 cases of oligoazoospermias in which sperm counts are less than 1 million per ml., and 104 cases of nullispermias in which no sperm are found under low power field of microscope).
2. An average age of the subjects was 34 An average duration of marital life was 3 years. An average frequency of sexual intercourse indicated 2 times per week. An average daily output of 17?ketosteroid was 9.4mg. Level of gonadotropin bioassay in 24 hours´ urine specimen showed less than 6 mouse uterine unit in 52 per cent, and more than 6 m.u.u. in 48 per cent.
3. In the present study, possible causative factors are testicular failure (134 cases), hormonal deficiencies (63 cases), low semen volume (15 cases), febrile diseases (13 cases), varicocele (10 cases), and unknown causes (39 cases).
4. Testicular biopsies which have been performed on 130 cases of azoospermias revealed that hyposperm atogenesis in 35 per cent, spermatogenic arrest in 23 per cent, germinal cell aplasia in 32 per cent, and peritubular fibrosis in. 10 per cent.
5. The clinical evaluation of treatment with various medications showed as follows:
1) Oligospermia group: consisted of 141 cases. Average duration of the treatment was 2.6 months.
() Group of thyronamin (T-group): Thyronamin (Takeda, Japan; triiodothyronine), 25mcg, was administered by mouth daily to 21 cases. Improvement was 33 per cent.
Q Group of thyronamin and vitamedin(TV-group): Twenty-five mcg of thyronan;in and 1 gm of vitamedin (Sankyo, japan, biotin; 100 mg; vitamin Phi 100 mg; vitamin B12, 1, 000 mg; and vitamin E, 300 mg) were given by mouth daily to 10 cases. Improvement: 40 per cent.
33 Group of thyronamin, vitamedin, and 1-arginin (TVL-group): Twenty-five mcg of thyronamin, 1 gm of vitamedin, and 500 mg of 1-arginin (Rikagaku, Japan; I-arginin monohydrochloride, amino acid) v, ere administered orally daily to 20 cases. Improvement: 45 per cent.
® Group of thyronamin, vitamedin, and AICAMIN (TVA-group): Twenty-five mcg of thyronamin, 1 gm of vitamedin, and 600 mg of AICAMIN (Fuiizawa, Japan; 4-amino-5-imidazole carbotamide orotate, nucleic acid precursor) were given orally daily to 9 cases. Improvement: 44 per cent.
C Group of H.C.G., male hormone, thyronamin, vitamedin, and 1-arginin (HMTVL-group): Twenty-five mcg of thyronamin, 1 gm of vitamedin, and 500 mg of 1; arginin were administered daily to 47 cases combined with puberogen (Tomoda, Japan; human chorionic gonadotropin), 1, 000 I.U., IM, every 3 days, and testosterone depot (Up John, U.S.A.), 100 mg, intramuscularly, twice a month. Improvement: 49 per cent.
ⓒ Group of H.C.G., male hormone, thyronamin, vitamedin, and AICAMIN (HMTVA-group): Twenty-five mcg of thyronamin, 1 gm of vitamedin, and 600 mg of AICAMIN were given daily to 8 cases combined with 1, 000 LU. of puberogen, every 3 days, and 100 mg of testosterone depot, twice a month. Improvement: 50 per cent.
Q7 Group of large doses of H. C.G., male hormone, thyronamin, vitamedin, and AICAMIN (HHMTVA-group) Twenty-five mcg of thyronamin, I gm of vitamedin, 600 mg of AICAMIN were administered daily to 5 cases combined with puberogen, 5, 000I. U., twice a week, and testosterone depot, 100 mg, twice a month. Improvement: 60 per cent.
® Group of Insam: Extract of 1 to 2 roots of Insam (Korean Jinsen, Korea) were given by mouth daily to 17 cases. Improvement: 29 per cent.
Q9 Group ;of rebound phenomenon with testosterone (Rebound-group): One hundred mg of testosterone depot were given intramuscularly weekly to 4 cases in order to induce "rebound p´ enosnenone". Improvement: 25 per cent.
Accordingly general improvement showed 43 per cent of the oligospermia group.
2) Azoospermia group: composed of 30 cases of oligoazoospermias (1-group), and 104 cases of nullispermias (0-group). Average duration of the treatment was 2. 5 months.
T. Group of H.C.G. shale hormone, thyronamin, vitamedin, and I-arginin (KMTVL-group): Thyronamin, vitamedin, 1-arginin, puberogen, and testosterone depot were administered to 62 cases in same manner of the group 5 of oligospermias. Improvement: 8 per cent.
02 Group of H.C.G., male hormone, thyronamin, vitamedin, and AICAMIN (HMTVA-group): Thyronamin, vitamedin, AICAMIN, puberogen, and testosterone depot were given to 56 cases in like manner of the group 6 of oligospermias. Improvement: 9 per cent.
Group of large doses of H . C. G. , male hormone, thyronamin, vitamedin, and AICAMIN (HHMTVA group): These medications were administered to 16 cases in same way of the group 7 of oligospermias. Improvement: 31 per cent.
General improvement in the azoospermia group revealed 11 per cent.
6. Semen values of pre- and post-treatment in the improved groups showed as follows:
1) Oligospermia group: volume increased from 2.2 ml. of pre-treatment values to 3. I ml. of post-treatment values, count increased from 26 million per ml: to 58 million per ml., motility increased from 40 per cent to 54 per cent, and morphology increased from 76 per cent to 78 per cent.
2) Azoospermia group: volume was 3.2 ml; count, 15 million per ml.; motility, 46 per cent; and morphology, 80 per cent after the treatment.
The author´s experience confirmed that, for the successful pregnancies to take place, the following conditions must be met. In the volume of 2 ml. of seminal fluid, the actual count of sperm must exceed 40 million per ml. including at least 60 per cent of actively motile sperm with 70 per cent of normal forms by stained smears.
8. The overall results obtained in this clinical study showed that significant improvements could be traced especially in sperm motitity and concentration only in the cases where the number of sperm before treatment were exceeded more than 10 million per ml.
9. It was noted that the milder the histologic changes of testis could be found in the group of azoospermias, the better the meddical combination treatment responded.
10. The combination treatment .´pith 5 different drugs, such as H.C.G., testosterone, liothyronin, vitamins, amino acid, and nucleic acid precursor, in the form of continuous medication at least for the period of 3 months, seems to be more effective than any others.

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