A randomized group of 101 oligospermic men, with low or normal serum follicle-stimulating hormone levels and infertile marriages of more than 2 years were studied with and without clomiphene citrate. For 6 to 9 months 56 patients were treated with 50 mg. clomiphene citrate daily and 45 men were given no treatment. Significant improvement in volume, sperm density and sperm motility was observed in the treated group but not in the control group. Sperm density greater than 20 times 10(6) per ml. was obtained in 18 men and there were 7 pregnancies in the treated group. In the control group 3 men had a sperm count greater than 20 times 10(6) per ml. and there was no pregnancy. This study showed statistically significant improvement in sperm parameters in the treated group but not in the untreated patients.

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Seminal plasma FSH, LH, prolactin, testosterone, and oestradiol were estimated in 41 infertile men with varicocele and 45 infertile men without varicocele who failed to impregnate their wives after 2 years of marriage and 30 fertile men. There was significant elevation of FSH in the seminal plasma of the infertile men with varicocele compared with the seminal plasma of the other infertile and fertile men. Seminal LH and prolactin values were similar in both infertile groups but significantly higher than in the fertile men. Testosterone and oestradiol levels in the seminal plasma of infertile men with varicocele were lower than in the fertile and the other infertile males. Finding that both steroids were decreased in infertile men with varicocele could explain disturbed function of spermatozoa in men with varicocele. Further analysis will elucidate the importance of these hormone findings in the seminal plasma of infertile men with varicocele.

Due to the absence of clinical symptoms, silent genital tract inflammation can be diagnosed only by laboratory tests. In this study we have evaluated seminal plasma elastase levels, using an immunoabsorbent assay, in a group of 84 infertile men. Seminal plasma levels of elastase were correlated with the number of white blood cells in the ejaculate, the number of peroxidase-positive leucocytes and with sperm culture. A high number of leucocytes (greater than 10) and a significantly higher number of men with peroxidase-stained leucocytes exceeding 10(6)/ml was found in a group of men with elastase levels greater than 250 ng/ml. There was a significant correlation between sperm culture results and elastase levels, most men with negative sperm culture having a lower seminal plasma elastase level. Following the treatment with antibiotics of men with an elevated elastase level, sperm parameters improved in 67% of those in whom elastase levels were lowered after treatment. In those men with persisting elevated levels of elastase improvement of sperm parameters was found in only 10%. It is concluded that an elevated level of elastase is a sensitive indicator of asymptomatic genital tract infection and that a single determination gives a reliable criterion and relatively exact quantification of infection.