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Clomiphene is thought to have an antiestrogenic effect and to enhance the release of gonadotropins from the pituitary. For these reasons, it was administered to 15 oligospermic infertile males that exhibited varying testicular derangements on biopsy to correlate any response with a particular histologic picture. Regardless of the pathology, no improvement in semen count was noted. In 4 cases, semen count depression followed therapy.

Several suggestions which are meant to help the physician avoid some potential problems with respect to vasectomy are made. The consent form should be signed by both the patient and his spouse and should describe in nontechnical terms the procedure to be performed, objectives of the procedure, the need for postsurgical examinations, and should state that there is no guarantee of success. A sample consent form is included. The procedure itself is described. It is very important that the removed vasa segments be sent to a pathologist for verification and that the right and left vas be labeled as such. Complications are discussed briefly and it is pointed out that in some cases litigation has occurred. It is recommended that semen analysis be done at 6, 9, and 12 months postoperatively in order to insure that recanalization has not occurred. These analyses are in addition to at least 2 specimens, preferably the 9th and 10th postoperatively, to verify the absence of sperm in the ejaculate.

Each of three technicians made duplicate pipettings from forty-six semen specimens ofseven donors and filled two haemocytometer chambers from each pipette. The number of spermatozoa in each of the four large corner squares of the chamber were counted and recorded separately for a total of 2208 counts on 552 chambers. An analysis of variance was made and the percentage variances were calculated. Marked variation was found in counts among technicians and in duplicate counts by the same technician. The technician term and the related technician interaction terms accounted for 14\m=.\8of the total study variance. Approximately one-halfof the variance of the haemocytometer technique itself was due to the variance among technicians (57\m=.\4%) and one-half to the variance among duplicate haemocytometer determinations by the same technician (42 \m=.\6%). The 95 % confidence interval for haemocytometer counts, among technicians, on a single specimen which is equal to the mean of this study (28 million/ml), is \m=+-\52%. The variance associated with the haemocytometer technique is large and must be considered in the design and analysis of studies of semen.

47 men who underwent bilateral vasectomy collected preoperative and 10 sequential postoperative semen samples in order to determine the number of postvasectomy ejaculations required to obtain aspermic semen. The studies indicate that 68% of the sperm remaining in the vasa distal to the vasectomy are ejaculated with each emission.

The spermiograms of 31 men were studied following voluntary vasectomy (resection and ligature of the vasa deferentia). The 1st spermiogram was done 1-4 weeks after operation, after 8 or more ejaculations, and succeeding spermiograms were done at 3-4 week intervals until aspermia was seen. In 2 patients, the proximal portions of the vasa were rinsed with physiological saline solution before ligation. These 2 patients were sterile at the 1st spermiogram. In the other 29 patients, sperm counts of 100,000-10,000,000/ml were seen after 3-4 weeks. At the 2nd spermiogram, 6 of these patients were sterile, wh ile sperm counts up to 3,000,000/ml were seen in the others. At the 3d spermiogram 10 patients had sperm counts up to 1,000,000/ml. In 2 patients, aspermia was reached only at 10 months. The author recommends post-vasectomy spermiograms until aspermia is shown, as well as histological examination of the resected portions of the vasa.

To the Editor:— I should like to call your attention to Dr. I. C. Rubin's article published inThe Journal(Dec. 28, 1946, page 1047) "Contraception Masking Sterility and Infertility." While most practitioners interested in the field of fertility in men would agree with Dr. Pollack and Dr. E. T. Tyler, who state in their letters to the editor of theThe Journal, November 8, page 682, that the normal range of sperms per cubic centimeter of semen is from 60 million to 120 million and that pregnancies seldom occur when the husband's count is considerably less than 50 million per cubic centimeter, Dr. Rubin, such an authority in fertility and sterility in women, makes in his article the following rather incredible statements: "in an appreciable number of cases the Huhner test showed 10 spermatozoa or less per high power field, despite which pregnancy has taken place," and, "Absence of

A questionnarie follow-up of 1,012 men who had vasectomies performed through the Simon Population Trust Vasectomy Project in 1966 and 1967 showed that reaction to the operation was overwhelmingly favorable: 99% of the respondents would recommend the operation to others. In more than half the cases, there was no change in health or sex life, but where there were changes, they were for the better about 50 times more often than for the worse. The report (Vasectomy: Follow-up of a thousand cases. Cambridge, England. Simon Population Trust Publication, December 1972) stresses that there were no pregnancies among couples who replied to the questionnaire.

9 months after vasectomy of a 58-year-old man, with substantial segments of the vas deferens removed, rare non-motile spermatozoa were found on 4 occasions. This probably represents persistent sperm remaining in the ductal system reservoir rather than indicating incomplete sterilization. Persistent sperm have been noted in patients up to 1 year after vasectomy. Sperm clearing time from the ejaculate tends to be variable and dependent upon the number of ejaculations. Older patients require more ejaculations to obtain sperm-free samples. Rare non-motile sperm are highly unlikely to result in conception. However, it is advisable not to consider the patient sterile until at least 4 months after the vasectomy with a minimum of 16 ejaculations and 2 consecutive sperm-free specimens.

That seminal (PG) prostaglandin in infertile males is much lower than in normal fertile men was reported recently. Possible roles of PG on fertility were also discussed. However, detailed data about the normal level of seminal PG in individuals have not been presented thus far, except some original descriptions. The present study presents the seminal PG contents in both infertile and fertile men. PGs were estimated biologically and/or spectrometrically after partial purification from semen. As related values were obtained with each method, measurements of optical density on alkali treated PG were done as a routine assay. Conventional classification of infertility was as follows: 1) azoospermia (no spermatozoa in semen), 2) oligospermia (spermatozoa than 50 millions/ml), and 3) normospermia (spermatozoa than 50 millions/ml). PG levels of those groups were: 1) 7.5 + or - 3.9 (8 cases), 2) 9.3 + or - 3.9 (29 cases), 3) 10.8 + or - 5.7 (21 cases) and normal men as controls 9.0 + or - 6.6 (17 cases). Fructose and cholesterol contents in seminal plasma were also determined in most of the cases. No particular relations were found between PG contents and these constituents. However, seminal fructose content was inversely proportional to that of cholesterol (r=0.66, n=20, p 0.01). Testosterone regulation of fructose production in seminal vesicles has been well established. Our results suggest there are hormonal controls for seminal cholesterol formation and for secretion but not for that of PG. Bergstrom et al have demonstrated the conversions of (EFA) essential fatty acids to PGs in vitro and have been led to postulate that EFA deficiency signs are due to lack of PGs. I examined the effects of EFA administration to patients on PG formation during the period of 2-12 weeks but PG levels in individuals are variable with time or conditions and definite tendencies have not yet been obtained. Further investigation is necessary. (Author's modified)

The potential fertility of 6 of 8 men accidentally exposed to radiation on June 16, 1958, was studied over a 3 1/2-year period. It is clear that, as measured by semen quality, evidence of recovery of spermatogenesis may be expected within 21 months, although the sperm counts at this time will probably not be consonant with a reasonable level of fertility. A satisfactory level of fertility will be reached by 30 months and a normal level by 41 months. Review of the male fertility data on the recorded cases of less than lethal nuclear radiation accidents shows that relatively small amounts of radiation will produce pronounced effects on the testes, including disturbances in the morphology of the few spermatozoa present in the ejaculate, but that ultimate recovery of some degree of fertility is possible in most cases.