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Spermatogenesis after parathyroidectomy in patients with symptomatic secondary hyperparathyroidism
Fong-Fu Chou1, Chiang-Hsuan Lee, Chien-Te Lee
1Department of Surgery, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung University, Kaohsiung Hsien, Taiwan, ROC.
Background:
The changes in spermatogenesis after parathyroidectomy in patients with symptomatic secondary hyperparathyroidism have not been reported before.
Study Design:
Nineteen men with symptomatic secondary hyperparathyrodism were enrolled in our study. Their ages ranged from 29 to 50 years and duration of dialysis from 72 to 168 months. Before operation, serum levels of calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone, prolactin, luteinizing hormone, follicle-stimulating hormone, and testosterone were checked routinely in association with semen analysis. Those data were checked again 3 months after successful operation. Finally, 15 patients had total parathyroidectomy with subcutaneous autotransplantation of 60 or 90 mg of tissue and complete postoperative data was available for 13 patients. The semen analysis included sperm density, volume of semen, motility index, percentage of active motility, and percentage of normal morphology.
Results:
Ten patients had normal sperm density (> or =20 x 10(6)/mL), and nine patients had oligospermia (<20 x 10(6)/mL) (n = 4) or azoospermia (n = 5). The ages of patients, duration of dialysis, and weight of removed parathyroid glands were quite similar between the two groups. The serum levels of calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone, prolactin, luteinizing hormone, follicle-stimulating hormone, and testosterone were not significantly different between the group with normospermia and the group with oligospermia or azoospermia. Three months after total parathyroidectomy with autotransplantation, the serum levels of calcium, phosphorus, alkaline phosphatase, and intact parathyroid hormone were markedly decreased; the percentage of active motility and motility index were markedly improved; the serum levels of prolactin, luteinizing hormone, follicle-stimulating hormone, and testosterone had no significant changes; and the volume of semen, sperm density, and percentage of normal morphology had no significant improvements. One patient, who had oligospermia with primary infertility, had paternity 6 months after parathyroidectomy, though his oligospermia remained unchanged at that time.
Conclusion:
After parathyroidectomy, the sperm motility index and percentage of active motility can be improved. We speculate that increases in fertilization and paternity in uremic male patients can be expected after surgery.