Clinical Investigations in Andrology

Abstract

This dissertation is a compilation of research on various topics encountered in real life Andrology clinical practice and research. Current day clinical consultation involves a spectrum of challenges from interpreting steroid hormones assays, infertility, hypogonadism, fertility preservation to complex genetic tests to diagnose and manage disorders of sexual differentiation (DSD). This thesis is an attempt to cover the broader aspects of Andrology, as encountered in daily practice. The 1st chapter is on the rate, extent and determinants of testicular function recovery in men using non-prescribed androgens. This was an observational study comparing current and past users along with controls concluding that suppressed testicular function is mostly reversible, recovery taking between 7 - 18 months after cessation of intake. Suppressed serum LH, FSH and AMH represent markers of androgen abuse and recovery. The 2nd chapter is a review of a sperm cryostorage database in a tertiary teaching hospital over 4 decades, describing pre-freeze semen parameters, hormones, disease types, accessibility in regional and rural areas, feasibility of cryostorage in adolescents and ultimately the disposal of stored samples – reasons and time taken for use or disposal. The 3rd chapter is a case report of a 17-year-old 46XX phenotypic male presenting with testicular pain due to ovulation into an ovotestis, diagnosed to have a SOX9 duplication resulting in ovo-testicular DSD. The 4th chapter is a paper comparing progesterone(P4) levels measured by radio immunoassay (IA) vs LC-MS in women undergoing IVF. IA consistently overestimated serum P4 levels so that low measurements were too inaccurate to be used quantitatively. The last chapter describes a study to improve IVF outcomes in women with poor ovarian response using transdermal dihydrotestosterone (DHT) gel, describing the research hypothesis, literature review of safety of testosterone use in women and the study protocol.