An infertile man presented a spermiogram in which 100% of the spermatozoa displayed separation of head from tail at the level of the proximal centriole. Most tails were normally structured and ended anteriorly with the proximal centriole covered by a continuous plasma membrane. In a small percentage of tails a rudimentary connecting piece was surrounded by a minute cytoplasmic mass and the middle piece was missing, whereas the chromatoid body and the spindle-shaped body were still present. Finally, a few tails had a large cytoplasmic mass surrounding either regular connecting and middle pieces or a rudimentary connecting piece continuous with the main piece. Tails of the first type had good forward motility, although the pattern of movement appeared altered. The other types were immotile or motile but without forward progression. In the loose heads the implantation fossa had failed to differentiate. The separation of heads from tails appeared to be the result of a specific morphogenetic defect and took place at different stages of spermatid differentiation, giving rise to the structurally different types of tails.

A 33-year-old man had azoospermia and tubular atrophy as in the Klinefelter syndrome but short stature. He had a 46,X,t(X/Y) (Xqter lead to p22.3::Yp11 lead to Yqter) translocation and was H-Y antigen-positive. This excludes one of the genes controlling H-Y antigen from the terminal portion of the short arm of the Y chromosome. This case and the two similar ones in the literature indicate that the proximal Yp portion is required for the differentiation of a male gonad. The pattern of X inactivation was random in the patient's fibroblasts, whereas in the lymphocytes the translocated chromosome was preferentially inactivated; comparison with other cases shows that the quantity of Y chromosome material involved in these translocations does not influence the X inactivation patterns. In the three cases with this dicentric translocation the X chromosome centromere is consistently the active one. Our case indicates that the choice of which centromere is inactivated is independent of the replication pattern of the X chromosome. Our patient and a few other relevant cases from the literature confirm that factors controlling height are located on the distal portion of Xp and of Yp.

No abstract

Zusammenfassung Es wird über eigene Erfahrungen in der Behandlung der sekretorischen Infertilität des Mannes berichtet, die während einer 20‐jährigen Tätigkeit am Zentrum für Fruchtbarkeit und Sterilität in Mailand erworben werden konnten. Résumé L'auteur rapporte les expériences propres dans le traitement de l'infertilité masculine. II a une expérience depuis 20 ans dans le centre de la fertilité et de la stérilité Milan. Summary In the foregoing the therapeutic approaches most extensively used during the last few years for conditions of male subfertility or sterility are elucidated; as indications, contraindications, short‐term effects and longterm outcomes of individual treatment are discussed, on the strength of a considerable number of cases observed during beyond 20 years of clinical experience in three “conjugal‐sterility advisory centers” in Milan.

No abstract