Summary. Intrascrotal temperatures were measured bilaterally by a non-invasive method in 300 subfertile men (mean sperm count 21 \m=.\4\m=x\ 106/ml) and 30 normospermic control men (mean sperm count 118\m=.\7\ m=x\106/ml). The subfertile men had mean (s.d.) temperatures of 34\m=.\7\s=deg\C (0\m=.\8) for the right and 34\m=.\8\s=deg\C (0\m=.\7) for the left testis. The value for both testes of the control men was 33\m=.\4\s=deg\C (0\m=.\6). The difference ( 1\ m=. \ 3\ p=n-\ 1\ m=. \ 4\ s=deg\ C) was significant (P = 0\m=.\03). An intrascrotal temperature of >34\m=.\1\s=deg\Cwas found in >83% of subfertile men, regardless of clinical diagnosis. This method can therefore be used to survey large numbers of men. We suggest that small intrinsic temperature increases may interfere with the ability of the testis to accommodate to environmental temperature stresses and so lead to abnormal semen and subfertility.

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We studied the use of a testicular hypothermia device worn daily for at least 16 weeks in 64 men with subfertile semen and elevated testicular temperature, who had had an infertile marriage for 2 or more years in which the wife was judged fertile. Improvement in 1 or more semen parameters was seen in 42 patients (65.6 per cent). Semen analysis was converted into the motile oval index, a numerical value representing the count, motility and normal morphology. The motile oval index helps to predict pregnancy outcome. Of 21 patients with pre-treatment motile oval indexes greater than 4.8 million per ml. 11 (52.4 per cent) produced pregnancy. Patients with lower starting indexes did not fare as well. Of 20 patients who met the criteria, and who wore the device for less than 2 weeks or not at all and had no other treatment 1 (5.0 per cent) produced pregnancy. Mean hypothermia time to date of missed menses was 4.2 months. Six patients with nonobstructive azoospermia showed no semen change with the testicular hypothermia device.

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