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Andrology-Prelims.qxd 3/16/2005 10:48 AM Page i Atlas of Clinical Andrology Andrology-Prelims.qxd 3/16/2005 10:48 AM Page ii Dedication This Atlas is dedicated to all scientists conducting physiological and clinical research leading to assisted conception and improved quality of life. Andrology-Prelims.qxd 3/16/2005 10:48 AM Page iii Atlas of Clinical Andrology by ESE Hafez and SD Hafez Co-Directors, Reproductive Health Center Kiawah Island, South Carolina, USA CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2005 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20130415 International Standard Book Number-13: 978-0-203-08788-6 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. 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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Andrology-Prelims.qxd 3/17/2005 3:59 PM Page v Contents Acknowledgements vii Preface ix Introduction xi SECTION I REPRODUCTIVE PHYSIOLOGY 1 Endocrinology of reproduction in men 3 2 Functional ultrastructure of testis and epididymis 15 3 Semen and the functional anatomy of sperm 29 4 Capacitation,acrosome reaction and fertilization 45 SECTION II REPRODUCTIVE PATHOLOGY 5 Testicular dysfunction and male infertility 61 6 Semen,sperm anomalies and infertility 81 7 Erectile dysfunction 99 8 Ejaculatory anomalies 109 SECTION III REPRODUCTIVE ANOMALIES 9 Immunological andrology 117 10 Andropause and osteoporosis 127 11 Prostate pathophysiology 135 12 Cardiovascular anomalies,infections and infectious diseases 147 SECTION IV ASSISTED REPRODUCTIVE TECHNOLOGY 13 Genetic andrology and genetic engineering 165 14 Molecular reproduction in men 181 15 Sperm processing 187 16 Micromanipulation and assisted conception 205 References 219 Index 227 Andrology-Prelims.qxd 3/16/2005 10:48 AM Page vi Andrology-Prelims.qxd 3/16/2005 10:48 AM Page vii Acknowledgements The authors are extremely grateful to Betty Hafez, Ms Dinah Alam for their sound advice and hard executive editor of the international journal Archives work.We are greatly indebted to friends and col- of Andrology,for her editorial skill and the very hard leagues who made the writing of this Atlas such a work needed to coordinate all the activities related satisfying experience. to review and proofread the manuscripts before Sincere thanks are due to the American Society of publication.She was also responsible for summariz- Andrology,the Society for the Study of Reproduction ing the tables in an easily readable form and for and the American Society of Andrology for giving giving full descriptions to the captions of the figures. permission to use illustrations from their journals. Without her efforts there would be no Atlas. In Dr Jane M. Morrell, R&D Manager of Nidacon AB particular we thank Ms Cindy Lloyd of Yorktown International,of Göteborg,Sweden was kind enough Street, James Island, SC for her elegant secretarial to provide us with original illustrations of the various and clerical help.We are indebted to several academ- procedures used in the purification of semen sam- ics who have allowed us to include their valuable ples,and,for freezing and thawing of human sperm, illustrations and research results in the Atlas,particu- CryoProtec®. Finally, we would also like to thank larly Professor Carl Pinkert (University of Alabama, those who answered our questions on the phone,via Birmingham,Alabama,USA).We thank the staff of e-mail or in personal conversation. the publishers Taylor & Francis Medical Books for giving generously of their intellect and expertise.We ESE Hafez and SD Hafez acknowledge especially Mr Nicholas J. Dunton and January 2005 vii Andrology-Prelims.qxd 3/16/2005 10:48 AM Page viii Andrology-Prelims.qxd 3/16/2005 10:48 AM Page ix Preface Andrology,the science of the physiology,pathology The chapters of this Atlas are multidisciplinary in and microbiology of male reproduction,is a field not nature, and in their range and depth they reflect well established in medicine,in science or in the pub- our intention to bridge the gap between basic and lic consciousness.Unlike gynecology,the science of clinical science.There are chapters devoted to lab- andrology is a young discipline and is currently gener- oratory techniques,and morphological,anatomical, ating some amazing new insights, as well as many biochemical,immunological,hereditary and microbi- new puzzling questions.Only in the past 20–25 years ological parameters and their clinical application. have researchers begun to specialize in andrology. Emphasis is placed on specific aspects as related to Remarkable advances have been accomplished in health and disease in men,e.g.hereditary aspects of assisted reproductive technology:in vitrofertilization prostate diseases, erectile dysfunction and unex- micromanipulation of reproductive products,intracy- plained infertility. toplasmic insemination, intrauterine insemination The Atlas covers three main areas in biomedical and in vitro manipulation of semen. sciences:reproductive physiology,reproductive dys- A few groups of enthusiastic researchers have function and modern assisted reproductive technol- devoted special attention to human andrology, and ogy.Emphasis is placed on endocrine mechanisms of rapid development is anticipated owing to the appli- the testes,spermatogenesis,sperm maturation,motil- cation of modern technology,which has advanced so ity and transport in the male/female reproductive spectacularly in recent years. tract, capacitation and fertilization.The functional This Atlas includes the most recent research ultrastructure of spermatozoa is presented,as shown findings in male endocrinology, neuroendocrinol- by transmission electron microscopy,scanning elec- ogy, growth factors, sperm quality/fertility, male tron microscopy and atomic force microscopy. immunology and molecular andrology. Recent advances in molecular genetics have a significant ESE Hafez and SD Hafez impact on the precision of assessing the psychopatho- Reproductive Health Center logical processes of spermatogenesis,Sertoli cells,sem- Kiawah Island, inal plasma, sperm capacitation and fertilization. South Carolina,USA ix Andrology-Prelims.qxd 3/16/2005 10:48 AM Page x

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Andrology, the science of the physiology, pathology and molecular biology of male reproduction, is a relatively new specialty that has become increasingly important with the advent of modern assisted reproductive techniques (ART). The Atlas of Clinical Andrology describes both normal and abnormal re