- Email: [email protected]
Effect of Semistarvation on Human Semen
Effect of Semistarvation on Human Semen Harold B. Hulme, M.D. *
is known concerning the effect of starvation on human semen except in the most general terms. In the treatment of male infertility, the advice is usually given to "be sure of an adequate intake of proteins, carbohydrates, fats, minerals and vitamins." Except in unusual circumstances, the average American diet does not allow the evaluation of starvation effects on semen. An excellent opportunity to study alterations in semen during starvation was created during the starvation-rehabilitation experiment carried out in the years 1945 and 1946 at the Laboratory of Physiological Hygiene, University of Minnesota. In this experiment, 36 "normal" male volunteer subjects between the ages of 20 and 33 were maintained for three months on a "good" diet, averaging 3492 calories daily per man. During this time, control data were obtained and standardized. Six months of semistarvation followed with the average daily intake reduced to 1570 calories. The diet was planned to simulate in quality and quantity the food available in western and central Europe under the conditions of severe food shortage during the second World War. The men lost, on the average, 24 per cent of their prestarvation weight. The semistarvation period was followed by three months of controlled rehabilitation. During this period, the men were placed in four caloric groups of 8 men each, 4 men having been dropped from the experiment. Their dietary intakes ranged from 2377 to 3392 calories daily. From this point on, diets were unrestricted. Comprehensive studies of several hundred items of measurement were LITTLE
From the Departments of Obstetrics and Gynecology, University of Minnesota and University of Utah. • Present Address: University of Utah College of Medicine, Salt Lake City, Utah. 319
320
HULME
[Fertility & Sterility
made in the appraisal of functions and characteristics of the subjects. The measurements ranged from the anthropometric to the psychiatric and included details of circulation, metabolism, psychomotor performance, and responses to standardized stresses, as well as all ordinary items of medical examination. The complete experiment and results obtained have been published in a two-volume report. Observations of the effects of semistarvation upon sexual fup.ction were not begun until the end of the six months' starvation period. During the last part of this phase of the experiment, the subjects complained of a sense of being old and of losing interest in matters pertaining to sex, among other subjective changes. Some expressed concern over the possibility of permanently "losing their manhood." The number of "dates" dropped drastically and those who continued to "date" found their relationships strained. Some of the men were surprised to find that this was true in even those cases where relations with their female companion had appeared to be based on intellectual, social, and group interests. Masturbation and nocturnal emissions were absent or greatly reduced. With the appearance of these marked symptoms of starvation, it was deemed advantageous to study in some detail the actual effect of the experiment on sexual function, particularly the changes produced in semen.
REVIEW OF LITERATURE An exhaustive review of the world's literature dealing with starvation effects on sexual function has been produced in the complete report of the Minnesota starvation experiment. 8 This review deals with amenorrhea, pregnancy statistics, secondary sex characteristics, morphologic changes in the female and male generative organs, estrone inactivation, excretion of 17-ketosteroids, gynecomastia, and sex differences in resistance to starvation. The present review includes only the observed effects of starvation on testicular morphology and on the semen itself, with a few references to psychosexual changes in starvation. Several authors (Beeli, Jackson, Krieger, L'Amy, Reach, Rubner, and Simmonds) have reported a reduction in size of testes during semistarvation. Nicolaeff, however, studying autopsy specimens from children 1 to 16 years of age who had died of starvation in the Ukraine, reported testicular weight equal to or exceeding normal for their ages. It should be stated, though, that in spite of normal testicle weight, these boys showed no
Vol. 2, No.4, 1951]
SEMISTARVATION AND HUMAN SEMEN
321
spermatogenesis upon reaching puberty. According to Hibbs, there was no evidence of significant change in the size of the testes in the underweight American men in Japanese prison camps. The men in the Minnesota experiment showed no obvious change in the size of the testes, though this factor was not studied adequately. As some investigators have shown, notably Michelson, the size of testes varies considerably and variations from "normal" are difficult to evaluate. Histologic changes and changes in the semen are more notable. In experimental animals these changes have been investigated by several observers. Menze and Morgulis and coworkers noted that starvation of rats resulted in cessation of spermatogenesis at the primary spermatocyte stage and in degeneration of the seminiferous tubules. Siperstein made the observation that testicular tissue was more resistant to the effects of starvation after sexual maturity than before. Moore and Samuels stated that the number of spermatozoa in semen was markedly diminished or absent following starvation; this and other findings resembled changes found following hypophysectomy according to Mulinos and Pomerantz. Several workers, including Mulinos, Pazos, and coworkers, observed that there was atrophy of the prostate gland and other secondary sex organs but this could be overcome by injections of testicular extracts and equine gonadotropin, even in the face of continuing undernutrition. The work of Poiarkov showed that in starvation of dogs, the volume of semen and the spermatozoa count both dropped markedly. These returned slowly to normal on forced feeding. In humans subjected to starvation, Cordes and Hausemann observed an increase in interstitial cells of the testes. Stefko, in a study of victims of the Ukrainian famine of 1922-23, reported on the testes of males of all ages. In infants there was atrophy of the seminiferous tubules and a complete absence of signs of spermatogenesis. In young boys the Sertoli cells appeared to have destroyed the spermatozoa and cryptorchidism was very frequent. In adult men complete atrophy of the seminiferous tubules was uncommon; the spermatozoa were degenerated and their remains, together with epithelial and Sertoli cells, filled the tubules with debris. The walls of the tubules were thickened with connective tissue. In most cases, there was a small remnant of spermatozoa in the epididymis. Klatskin and others made the observation that some of the men who had been subjected to severe semistarvation while imprisoned in Japanese camps had atrophic testes. On biopsy these showed "hyalinization of the seminif-
322
HULME
[Fertility & Sterility
erous tubules with normal-appearing interstitial cells." These examinations were not made until after about four months' intensive rehabilitation following release from the prison camps. Most of the weight loss had been regained, but "many of them rioted loss of potency at this time, as indicated by a failure of erection, premature ejaculation, or loss of orgasm." Semen specimens were secured and showed sperm count and motility both decreased. In a later report concerning American soldiers in Japanese prison camps, Jacobs reported loss of libido and absence of nocturnal emissions in the early months of semistarvation. In spite of fears of sterility and impotence on the part of these soldiers after forty months' semistarvation, at least a normal number of them had demonstrated their fertility by impregnating their wives and fathering normal babies within two years after liberation. Miles reported marked diminution in general sex interest, number of nocturnal emissions, frequency of erection, and desire for association with the opposite sex during periods of starvation.
DESCRIPTION OF EXPERIMENT In the following discussion and in the tables, the time at which specimens were collected is designated by S or R. Thus, 24S refers to the twentyfourth week of starvation and 6R refers to the sixth week of rehabilitation. Semen specimens were collected by masturbation at the end of semistarvation (24S) by 16 of 29 volunteers for this part of the experiment. Four men (of the 32 in the total experiment) refused to produce a semen specimen for personal reasons. Twelve of the 28 who attempted a collection were unable to do so. Their failures were due to several factors. Several of the men complained that they were unable to produce an erection even after prolonged attempts. Others obtained an erection but no orgasm. One subject experienced the subjective feelings of an orgasm but produced no semen. Many of those who were successful in producing a semen specimen remarked on the great exertion required. In addition to the original specimen, 12 men collected a second specimen 5 days after the first (25S). This provided an opportunity to study the ability of the generative tract to produce normal semen specimens at 5-day intervals. Specimens were then obtained after 6, 11, and 20 weeks' rehabilitation (6R, HR, 20R). Four of the subjects were contacted 57 weeks (57R) following the end of semistarvation and provided specimens at that time. Mter
___________________________________________________________
~
______________
~
Vol. 2, No.4, 1951]
SEMISTARVATION AND HUMAN SEMEN
323
20 weeks of rehabilitation only 6 of the subjects failed to obtain specimens, as compared with 12 who failed to do so at the end of semistarvation. During rehabilitation, the sexual impulses, needs, and interests were very slow in regaining their pre-experimental intensity. Collection of semen specimens by masturbation became much less difficult as rehabilitation progressed. Frequency of nocturnal emissions and masturbation remained essentially unchanged from the beginning of rehabilitation until the twentieth week. There was no heterosexual activity. Sexual behavior at 57R is not known, however, since the subjects were not under experimental control at that time. All specimens were maintained at 10° C. in a refrigerator during their observation. They were initially examined within three hours of their collection, determinations being made of volume, viscosity, turbidity, pH, spermatozoa count, percentage of motile spermatozoa, and quality of motility. Direct smears were made and stained with methylene blue for study of the morphology. The specimens were checked at hourly intervals to determine the duration of motility of the spermatozoa. Determinations were all made by technics outlined by Hotchkiss. Results of the experiment are presented in four tables. Table 1 gives the results of individual determinations on each of the subjects throughout the experiment, except for subjects who were unable to collect specimens before 20R. Table 2 shows the mean values in 12 men from whom two specimens were collected 5 days apart. In Tables 3 and 4 are listed respectively the mean values of determinations in the total group and in the group of four subjects whose last semen specimens were collected after 57 weeks of rehabilitation. Standard deviations are not given because the data depart widely from a normal probability distribution. The mean values are presented only for what they are worth and can be compared with reservation to values accepted as normal for each category. Normal value ranges are included in each table for comparison. There is marked deviation in response of individual subjects to ~emi starvation and to rehabilitation, as stated above. In some instances these variations are doubtless due to errors in observations. In others, unknown biologic factors probably account for the deviations. Some of these variations have been discussed, but it does not appear practical to take up each one individually. A comparison of the specimens collected 5 days apart (Table 2) showed
TABLE l.
..,
Co>
Data on Semen Studies
.....
pH
Count (million / cc.)
Total sperm (million/ ejac)
7-8 8 8 7 7
40 -300 25.0 25.0 105.0 65.0
80 -1000 2.5 5.0 42.8 117.0
70 OR MORE 51.0 55.0 72.1 70.5
3.9
65.5
30
1+
8.0
80 50
2+ 2+
24.0 24.0
Longevity (hr.)
Date
E.c.
24S 25S 6R 11R
2-5 0.1 0.2 0.4 1.8
C.F.
24S 25S 6R 11R
0.1 0.1 0.3 0.4
2+ 2+ 2+ 2+
2+ 1+ 3+ 3+
6 6 7 8
160.0 495.0
48.0 198.0
82.6 76.5
S.B.L.
24S 25S 6R 11R
0.5 0.2 0.35 1.1
3+ 2+ 1+ 2+
4+ 3+ 1+ 1+
7 8 8 8
1500.0 180.0 16.5 2.5
750.0 36.0 5.8 2.8
66.2 71.7 81.0 72.4
P. L.
25S 6R 11R 20R 57R
3.5 4.0 5.0 4.5 7.0
2+ 3+ 1+ 3+ 2+
4+ 3+ 3+ 2+ 2+
8 7 8 8
730.0 340.0 62.5 70.0 150.0
2555.0 1360.0 312.5 315.0 1050.0
68.1 71.4 88.0 67.0 76.0
30 50 60 60 90
2+ 3+ 2+ 2+ 3+
7.5 18.5 24.0 32.0 24.0+
24S 6R 11R
0.45 0.9 5.0
2+ 3+ 3+
3+ 3+ 3+
7 7 7
745.0 770.0 105.0
335.3 693.0 525.0
56.3 56.8 55.8
80 80 90
3+ 3+ 3+
12.0 24.0 31.0
24S 25S
0.2 0.35
2+ 4+
6 7
Subject
NORMAL RANGE
R.T.L.
R.T.M.
Viscosity
Turbidity
2+ -3+ 2+ -3+ 1+ 1+ 1+ 1+ 3+ 2+ 2+ 2+
2+ 2+
39.0
% Morphology (% normal) Motile
Quality of motility
Volume (cc.)
60 OR MORE 2+ -3+ 60 2+ 30 1+ 30 2+
24 OR MORE 7.5 7.5 6.0
qns J:
c: 0-
~ m
~
'T1
.,
CD
'< I/O III
.,CD
630.0
220.5
51.7
30
2+
5.0
-
'<
<
0
Subject
Date
Volume (cc.)
Viscosity
Turbidity
pH
Count (million/ cc.)
Total sperm (million/ ejac)
NORMAL
7-8 7 7
MORE
~
53.5 76.0 79.5 79.0
30 40 25 90
2+ 2+ 2+ 3+
7.0 20.0 23.0 24.0+
120.0 90.0 72.0 20.0
360.0 225.0 165.6 44.0
49.8 57.7 60.8 77.5
30 10 50 15
2+ 1+ 3+ 2+
7.0 3.0 16.0 13.0
340.0 292.5 30.0 35.0
1190.0 1023.8 135.0 245.0
69.2 82.0 64.1 71.5
40 40 80 60
2+ 2+ 3+ 2+
4.5 24.0 36.0 24.0+
7 7 7 7
1470.0 2710.0 1780.0 255.0
441.0 813.0 267.0 229.5
79.5 76.8 73.7 80.5
70 40 10 50
3+ 2+ 2+ 2+
8.0 5.5 19.0 17.0
8 8 8
355.0 200.0 500.0
710.0 280.0 1050.0
54.9 64.0 81.5
20 50 10
2+ 2+ 1+
7.0 7.0 15.0
2+ 3+ 2+ 2+
4+ 3+ 3+ 3+
7 7 7
24S 25S 6R 11R
3.0 2.5 2.3 2.2
1+ 2+ 2+ 2+
2+ 4+ 3+ 2+
8 7 7 7
25S 11R 20R 57R
3.5 3.5 4.5 7.0
2+ 2+ 3+ 3+
4+ 3+ 2+ 3+
7 7 7
D.J.P.
24S 25S 6R 11R
0.3 0.3 0.15 0.9
3+ 3+ 3+ 3+
4+ 4+ 3+ 3+
W.R.
24S 25S 11R
2.0 1.4 2.1
2+ 2+ 2+
3+ 3+ 3+
R. M.
1220.0 795.0 130.0 200.0
MORE
24 OR
3660.0 3577.5 715.0 1900.0
3.0 4.5 5.5 9.5
L.W.M.
80 -1000 227.5 161.0 210.0
60 OR
!"
90 100 80
25S 6R 11R 57R
W.T.M.
40 - 300 175.0 70.0 60.0
70 OR
z0
Longevity (hr.)
88.5 78.5 87.5
11R 20R 57R
2+ -3+ 2+ -3+ 3+ 1+ 2+ 3+ 2+ 1+
% Morphology (% normal) Motile
2+ -3+ 3+ 3+ 3+
2-5 1.3 2.3 3.5
RANGE
.!"
Quality of motility
:;;
MORE
23.0 34.0 24.0+
UI
m
;:
....UI
>
'" <
>
::
0
z >
z 0
:I:
c ;:
>
z
UI
m
;: m
z
'".......,
w
TABLE 1.-CContinuedJ
pH
Count (million/ cc.)
Total sperm (million/ ejac)
7-8 7 7 7 7
40 -300 165.0 75.0 230.0 27.5
80 - 1000 825.0 420.0 1495.0 109.0
Date
Volume (cc.)
W.S.
24S 25S 6R 11R
2-5 5.0 5.6 6.5 4.0
R.S.
24S 25S 6R 11R 20R
1.1 0.9 1.8 1.5 6.0
2+ 2+ 2+ 2+ 3+
4+ 4+ 3+ 2+ 3+
7 8 7 7 7
430.0 730.0 320.0 100.0 25.0
24S 25S 6R 11R
0.2 0.4 0.2 1.6
3+ 4+ 2+ 3+
3+ 3+ 2+ 1+
7 8 8 7
24S 25S 6R 11R 20R
1.7 1.0 1.3 3.0 2.5
1+ 2+ 1+ 2+ 2+
3+ 2+ 1+ 3+ 2+
24S 25S 6R 11R 20R
0.5 0.1 0.7 0.5 4.5
2+ 2+ 2+ 2+ 1+
3+ 2+ 2+ 2+ 2+
Subject
Viscosity
Turbidity
IV
a-
NORMAL RANGE
M.S.
K.D.T.
C.W.
2+ -3+ 2+ -3+ 2+ 3+ 1+ 1+ 3+ 3+ 2+ 2+
% Morphology (% normal) Motile
700B
60 OR
MORE
MORE
Quality of motility
Longevity (hr.)
24 OR
71.7 72.0 66.3 79.0
60 30 20 50
2+ -3+ 3+ 1+ 1+ 2+
473.0 657.0 576.0 150.0 150.0
85.3 70.0 69.0 72.0 86.5
90 20 75 50 90
3+ 1+ 2+ 3+ 3+
4.5 7.0 24.5 15.5 35.0
367.0 1410.0 750.0 80.0
73.4 564.0 150.0 128.0
71.5 60.5 81.9 74.5
20 5
2+ 1+
5.0 4.5
5
1+
6.0
8 8 8 8 7
120.0 105.0 130.0 17.5 1.0
204.0 105.0 169.0 52.5 2.5
84.3 71.5 75.2 67.0 75.2
10 30 50 40 90
1+ 2+ 2+ 2+ 3+
4.5 6.5 14.5 13.3 32.0
7 8 7 7 7
96.0 195.0 74.0 158.0 2.0
48.0 19.5 51.8 79.0 9.0
68.0 69.0 72.1 78.0 79.0
20 10 20 25 15
1+ 1+ 2+ 1+ 2+
7.5 6.0 11.0 19.5 30.0
MORE
6.0 7.8 23.5 23.0
::t:
c .... ~ m
."
CD ~
-< I/O U> CD ~
-<
--
"
'" TABLE 2.
Date
"'
% Motility
Longevity (hr.)
Morphology (% normal)
388.7 312.5
34.2 21.3
5.3 5.0
68.0 67.1
80-1000
60 or more
24 or more
70 or more
Volume (ee.)
Count (million/ ee.)
Total sperm (million/e;ae)
1.2 1.4
464.8 572.0
2-5
40-300
7-24-45 7-29-45 NORMAL RANGE
< 0
Average of Semen Factors in 12 Men at 5-Day Intervals in the Twenty-fourth Week of Semistarvation
!'> Z
? !"
:;;
-'" (J)
TABLE 3.
Week
24S 6R llR 20R NORMAL RANGE
m
Average Semen Factors in Total Group of Subjects
~ (J)
Number of sub;ects
Volume ( ee.)
Count (million/ ee.)
Total (million/ e;ae)
16 13 16 6
1.6 1.8 2.4 4.2
514.8 426.3 158.7 43.3
2-5
40-300
% Motile
Longevity (hr.)
Morphology (% normal)
775.4 661.2 264.2 185.4
36.9 38.8 34.0 75.0
5.4 15.1 16.6 33.0
65.9 72.2 77.8 71.8
80-1000
60 or more
24 or more
70 or more
.... >
'" < > ::: 0
z > z c
::t C ~
> z TABLE 4.
Average Semen Factors in Four Subjects in Whom Specimens Were Available at Fifty-seventh Week of Rehabilitation
Week
24S 6R llR 20R 57R NORMAL RANGE
(J)
m ~ m
Volume (ee.)
Count (million/ ee.)
Total sperm (million/ eiae)
% Motile
Longevity (hr.)
Morphology (% normal)
2.5 3.0 3.8 3.8 6.8
730.0 568.0 165.0 56.7 111.3
2,468.4 2,468.7 569.7 203.7 851.3
33.3 45.0 47.5 80.0 80.0
4.8 19.0 20.8 25.5 over 24
63.6 73.7 84.5 69.9 78.5
2-5
40-300
80-1000
60 or more
24 or more
70 or more
z
w
to.> '01
328
HULME
[Fertility & Sterility
no significant difference between the mean values. The lower percentage motility in the second sample is of doubtful significance. This tends to indicate that starvation does not retard the ability of the male generative tract to restore semen to its original quality if a rest period is allowed between ejaculations. The viscosity, turbidity, and pH of semen specimens showed no characteristic change at the end of semistarvation or during rehabilitation. At the end of semistarvation (24S) the mean values for all major items were beyond values generally considered normal (Table 3). The mean volume of ejaculate at 24S was 1.6 cc. Eleven of the 16 specimens were 2.0 cc. or less. During rehabilitation the mean volume returned to normal range some time between the eleventh and twentieth week. At llR only 8 specimens were below 2.0 cc. and at 20R all were greater than 2.0 cc. in volume. The mean spermatozoa count in millions per cubic centimeter and the mean total spermatozoa count were both found to be markedly elevated at the end of semistarvation. The variation in values in these items among the subjects was greater than in any other. One subject showed no spermatozoa at the end of semistarvation, but later had normal values. Only 3 subjects (E.c., C.F., RT.M.) produced fewer than 40 million spermatozoa per cubic centimeter and most of them ranged unusually high. The high spermatozoa count may be accounted for, at least in part, by the low volume of the corresponding specimens, resulting in relative concentration of the spermatozoa. This is shown by the relatively low total spermatozoa in the ejaculate. This does not explain the findings in W.T.M., however, who produced 1200 million spermatozoa per cubic centimeter in a volume of 3.0 cc., or a total of 3660 million spermatozoa per ejaculate. His values, and the fact that he showed consistently high spermatozoa production throughout rehabilitation, must be attributed to an exceedingly fruitful set of seminiferous tubules. At the end of semistarvation the mean spermatozoa count was elevated. Through rehabilitation the count diminished, reaching normal ranges at about 11 weeks (llR). After 11 weeks of rehabilitation, 5 subjects showed spermatozoa counts lower than 40 million per cubic centimeter. Four specimens (RM., RS., K.D.T., C.W.) were also deficient in spermatozoa after 20 weeks of rehabilitation. The mean percentage of motile spermatozoa was far below normal at the end of semistarvation. Only 2 of the 16 specimens showed more than 70 per
Vol. 2, No.4, 1951]
SEMISTARVATION AND HUMAN SEMEN
329
cent of the spermatozoa to be motile. In contrast to most of the other semen factors, the motility did not begin to increase markedly until after 11 weeks of rehabilitation. The percentage of motility was apparently normal at 20 weeks of rehabilitation (20R). The percentage of motility remained low or absent in several individuals, even after rehabilitation. Most notable are subjects E.G, S.B.L., and M.S. It is difficult to account for this factor. These subjects all showed low volume of semen, and the absence of motility at three hours after collection may be due to malfunction of the prostate and/or seminal vesicles, resulting in absence of proper substrate for motility of the spermatozoa. Semistarvation may have resulted in interference with spermatogenesis to the point that the spermatozoa are rendered incapable of responding to stimulation to motility. S.B.L., particularly, is notable in absence of motility in every specimen studied. The longevity of the spermatozoa was also drastically reduced at the end of semistarvation. In every subject the spermatozoa ceased activity long before twenty-four hours. This factor, along with the motility, was retarded in returning to normal during rehabilitation. In most instances, the spermatozoa lived twenty-four hours or longer after 11 weeks and none were below this level at the end of 20 weeks of rehabilitation. The percentage of normal spermatozoa (morphology) was not markedly affected by semistarvation. There was no great change over the period of rehabilitation. The most common abnormality encountered at the end of semistarvation was one in which the tail was tightly coiled about the head of the spermatozoon and the whole structure encased in protoplasm which had not yet been cast off the spermatozoon. This was interpreted as being an immature or incompletely developed spermatozoon. Table 4 shows in general the same values and same trends throughout rehabilitation as those in Tables 1 and 3.
SUMMARY The literature has been reviewed pertaining to the effect of starvation on testicular morphology and semen with a few references to psychosexual changes in starvation. Semen specimens were collected from 16 men who had undergone semistarvation for a period of 24 weeks. Twelve of these men submitted a second specimen 5 days after the :Srst. Specimens were also collected after 6, 11,
330
HULME
[Fertility & Sterility
and 20 weeks of dietary rehabilitation and on 4 subjects after 57 weeks of rehabilitation. All specimens were analyzed by routine methods. The following conclusions can be drawn from this study: 1. Semistarvation of normal men produces marked loss of interest in sex and diminution in sexual function. 2. Semen produced by subjects who have undergone semistarvation exhibits profound changes from normal characteristics. The volume of ejaculate is lower than normal, as are the motility and longevity of spermatozoa. The spermatozoa count is above normal at first. It later drops to normal and below normal in individual instances. There is no demonstrable change in viscosity, turbidity, pH, or morphology. 3. In semistarvation, there is no loss of the normal generative tract capacity to produce a second semen specimen of the same quality as one produced 5 days previously. 4. Sex interest, sexual function, and semen qualities return to normal after 11 to 20 weeks of adequate nourishment. The psychologic aspects of sexual functions return more slowly than semen factors. REFERENCES 1. Beeli, S. S.: Report in Jackson, C. M., Inanition and Malnutrition. Philadelphia, The Blakiston Company, 1925. 2. Cordes, H.: Arch. f. path. Anat. 151:402, 1898. 3. Hausemann, D. V.: Arch. f. Anat. u. PhysioI. p. 176, 1896. 4. Hibbs, R E.: Am. J. M. Sc. 213:176, 1947. 5. Hotchkiss, R. S.: Fertility in Men. Philadelphia, J. B. Lippincott Co., 1944, pp. 102-134. 6. Jackson, C. M.: Inanition and Malnutrition. Philadelphia, The Blakiston Company, 1925. 7. Jacobs, E.: J. Clin. Endocrinol. 8:227, 1948. 8. Keys, A., and others: Biology of Human Starvation. Minneapolis, University of Minnesota Press, 1950. 9. Klatskin, W., and others: Am. J. M. Sc. 213:19,1947. 10. Krieger, M.: Ztschr. f. ang. Anat. 7:87, 1920. 11. L'Amy, M., Lamotte, M., and Lamotte-Barillon, S.: Bull. et memo Soc. med d. hOp. de Paris. 62:435, 1946. 12. Menze, W.: EndokrinoI. 24:159, 1941. 13. Michelson, L.: Unpublished data. 14. Miles, W. R.: J. Nerv. & Ment. Dis. 49:208, 1919. 15. Moore, C. R., and Samuels, L. T.: Am. J. Physiol. 96:278, 1931. 16. Morgulis, S., Howe, P. E., and Hawk, P. B.: BioI. Bull. 28:397, 1915. 17. Mulinos, M. G., and Pomerantz, L.: J. Nutrition 19:493,1940. 18. Mulinos, M. G., and Pomerantz, L.: Endocrinology 29:267, 1941. 19. Nicolaeff, P.: Presse med. 31:1007, 1923. 20. Pazos, R, Jr., and Huggins, c.: Endocrinology 36:416, 1945.
I
Vol. 2, No.4, 1951]
SEMISTARVATION AND HUMAN SEMEN
331
21. Poiarkov, E. L.: Compt. rend. Soc. de bioI. 74:141, 1913. 22. Reach, F.: Wien. klin. Wchnschr. 31:1249, 1918. 23. Rubner, R.: Report in Reichsgesundheitsrat, December 20, 1917. Abstract, Mil, Surgeon 45:237, 1919. 24. Simmonds, M., in Aschoff, L.: Pathologische Anatomie. Jena, Gustav Fischer, vol. 2. 25. Siperstein, D. M.: Anat. Rec. 20:355, 1921. 26. Stefko: Rev. Franc. d'Endocrinol. 6:103, 1928.
Inaugural Meeting: Sociedade Brasileira de Esterilidade The Brazilian Sterility Society will hold its first meeting at the Hotel Gloria in Rio de Janeiro from October 14-19, 1951. Some sixty eminent contributors to the study and treatment of infertility have been invited to speak. The tentative program covers all phases of the subject from the academic to the clinical. Among the many topics discussed will be the physiology and pathology of spermatogenesis, ovulation, fertilization, and nidation; the endometrial cycle, the Rh factor, abortion; standard diagnostic procedures in the male and female, investigation of cervical, tubal, and ovarian function, and finally, the planning of a medical program to prevent and treat sterility on a nationwide basis. Detailed information about the convention may be obtained from the President, Dr. A. Campos da Paz, Filho, Avenida Mem de Sa, 197, Rio de Janeiro, Brazil.
is known concerning the effect of starvation on human semen except in the most general terms. In the treatment of male infertility, the advice is usually given to "be sure of an adequate intake of proteins, carbohydrates, fats, minerals and vitamins." Except in unusual circumstances, the average American diet does not allow the evaluation of starvation effects on semen. An excellent opportunity to study alterations in semen during starvation was created during the starvation-rehabilitation experiment carried out in the years 1945 and 1946 at the Laboratory of Physiological Hygiene, University of Minnesota. In this experiment, 36 "normal" male volunteer subjects between the ages of 20 and 33 were maintained for three months on a "good" diet, averaging 3492 calories daily per man. During this time, control data were obtained and standardized. Six months of semistarvation followed with the average daily intake reduced to 1570 calories. The diet was planned to simulate in quality and quantity the food available in western and central Europe under the conditions of severe food shortage during the second World War. The men lost, on the average, 24 per cent of their prestarvation weight. The semistarvation period was followed by three months of controlled rehabilitation. During this period, the men were placed in four caloric groups of 8 men each, 4 men having been dropped from the experiment. Their dietary intakes ranged from 2377 to 3392 calories daily. From this point on, diets were unrestricted. Comprehensive studies of several hundred items of measurement were LITTLE
From the Departments of Obstetrics and Gynecology, University of Minnesota and University of Utah. • Present Address: University of Utah College of Medicine, Salt Lake City, Utah. 319
320
HULME
[Fertility & Sterility
made in the appraisal of functions and characteristics of the subjects. The measurements ranged from the anthropometric to the psychiatric and included details of circulation, metabolism, psychomotor performance, and responses to standardized stresses, as well as all ordinary items of medical examination. The complete experiment and results obtained have been published in a two-volume report. Observations of the effects of semistarvation upon sexual fup.ction were not begun until the end of the six months' starvation period. During the last part of this phase of the experiment, the subjects complained of a sense of being old and of losing interest in matters pertaining to sex, among other subjective changes. Some expressed concern over the possibility of permanently "losing their manhood." The number of "dates" dropped drastically and those who continued to "date" found their relationships strained. Some of the men were surprised to find that this was true in even those cases where relations with their female companion had appeared to be based on intellectual, social, and group interests. Masturbation and nocturnal emissions were absent or greatly reduced. With the appearance of these marked symptoms of starvation, it was deemed advantageous to study in some detail the actual effect of the experiment on sexual function, particularly the changes produced in semen.
REVIEW OF LITERATURE An exhaustive review of the world's literature dealing with starvation effects on sexual function has been produced in the complete report of the Minnesota starvation experiment. 8 This review deals with amenorrhea, pregnancy statistics, secondary sex characteristics, morphologic changes in the female and male generative organs, estrone inactivation, excretion of 17-ketosteroids, gynecomastia, and sex differences in resistance to starvation. The present review includes only the observed effects of starvation on testicular morphology and on the semen itself, with a few references to psychosexual changes in starvation. Several authors (Beeli, Jackson, Krieger, L'Amy, Reach, Rubner, and Simmonds) have reported a reduction in size of testes during semistarvation. Nicolaeff, however, studying autopsy specimens from children 1 to 16 years of age who had died of starvation in the Ukraine, reported testicular weight equal to or exceeding normal for their ages. It should be stated, though, that in spite of normal testicle weight, these boys showed no
Vol. 2, No.4, 1951]
SEMISTARVATION AND HUMAN SEMEN
321
spermatogenesis upon reaching puberty. According to Hibbs, there was no evidence of significant change in the size of the testes in the underweight American men in Japanese prison camps. The men in the Minnesota experiment showed no obvious change in the size of the testes, though this factor was not studied adequately. As some investigators have shown, notably Michelson, the size of testes varies considerably and variations from "normal" are difficult to evaluate. Histologic changes and changes in the semen are more notable. In experimental animals these changes have been investigated by several observers. Menze and Morgulis and coworkers noted that starvation of rats resulted in cessation of spermatogenesis at the primary spermatocyte stage and in degeneration of the seminiferous tubules. Siperstein made the observation that testicular tissue was more resistant to the effects of starvation after sexual maturity than before. Moore and Samuels stated that the number of spermatozoa in semen was markedly diminished or absent following starvation; this and other findings resembled changes found following hypophysectomy according to Mulinos and Pomerantz. Several workers, including Mulinos, Pazos, and coworkers, observed that there was atrophy of the prostate gland and other secondary sex organs but this could be overcome by injections of testicular extracts and equine gonadotropin, even in the face of continuing undernutrition. The work of Poiarkov showed that in starvation of dogs, the volume of semen and the spermatozoa count both dropped markedly. These returned slowly to normal on forced feeding. In humans subjected to starvation, Cordes and Hausemann observed an increase in interstitial cells of the testes. Stefko, in a study of victims of the Ukrainian famine of 1922-23, reported on the testes of males of all ages. In infants there was atrophy of the seminiferous tubules and a complete absence of signs of spermatogenesis. In young boys the Sertoli cells appeared to have destroyed the spermatozoa and cryptorchidism was very frequent. In adult men complete atrophy of the seminiferous tubules was uncommon; the spermatozoa were degenerated and their remains, together with epithelial and Sertoli cells, filled the tubules with debris. The walls of the tubules were thickened with connective tissue. In most cases, there was a small remnant of spermatozoa in the epididymis. Klatskin and others made the observation that some of the men who had been subjected to severe semistarvation while imprisoned in Japanese camps had atrophic testes. On biopsy these showed "hyalinization of the seminif-
322
HULME
[Fertility & Sterility
erous tubules with normal-appearing interstitial cells." These examinations were not made until after about four months' intensive rehabilitation following release from the prison camps. Most of the weight loss had been regained, but "many of them rioted loss of potency at this time, as indicated by a failure of erection, premature ejaculation, or loss of orgasm." Semen specimens were secured and showed sperm count and motility both decreased. In a later report concerning American soldiers in Japanese prison camps, Jacobs reported loss of libido and absence of nocturnal emissions in the early months of semistarvation. In spite of fears of sterility and impotence on the part of these soldiers after forty months' semistarvation, at least a normal number of them had demonstrated their fertility by impregnating their wives and fathering normal babies within two years after liberation. Miles reported marked diminution in general sex interest, number of nocturnal emissions, frequency of erection, and desire for association with the opposite sex during periods of starvation.
DESCRIPTION OF EXPERIMENT In the following discussion and in the tables, the time at which specimens were collected is designated by S or R. Thus, 24S refers to the twentyfourth week of starvation and 6R refers to the sixth week of rehabilitation. Semen specimens were collected by masturbation at the end of semistarvation (24S) by 16 of 29 volunteers for this part of the experiment. Four men (of the 32 in the total experiment) refused to produce a semen specimen for personal reasons. Twelve of the 28 who attempted a collection were unable to do so. Their failures were due to several factors. Several of the men complained that they were unable to produce an erection even after prolonged attempts. Others obtained an erection but no orgasm. One subject experienced the subjective feelings of an orgasm but produced no semen. Many of those who were successful in producing a semen specimen remarked on the great exertion required. In addition to the original specimen, 12 men collected a second specimen 5 days after the first (25S). This provided an opportunity to study the ability of the generative tract to produce normal semen specimens at 5-day intervals. Specimens were then obtained after 6, 11, and 20 weeks' rehabilitation (6R, HR, 20R). Four of the subjects were contacted 57 weeks (57R) following the end of semistarvation and provided specimens at that time. Mter
___________________________________________________________
~
______________
~
Vol. 2, No.4, 1951]
SEMISTARVATION AND HUMAN SEMEN
323
20 weeks of rehabilitation only 6 of the subjects failed to obtain specimens, as compared with 12 who failed to do so at the end of semistarvation. During rehabilitation, the sexual impulses, needs, and interests were very slow in regaining their pre-experimental intensity. Collection of semen specimens by masturbation became much less difficult as rehabilitation progressed. Frequency of nocturnal emissions and masturbation remained essentially unchanged from the beginning of rehabilitation until the twentieth week. There was no heterosexual activity. Sexual behavior at 57R is not known, however, since the subjects were not under experimental control at that time. All specimens were maintained at 10° C. in a refrigerator during their observation. They were initially examined within three hours of their collection, determinations being made of volume, viscosity, turbidity, pH, spermatozoa count, percentage of motile spermatozoa, and quality of motility. Direct smears were made and stained with methylene blue for study of the morphology. The specimens were checked at hourly intervals to determine the duration of motility of the spermatozoa. Determinations were all made by technics outlined by Hotchkiss. Results of the experiment are presented in four tables. Table 1 gives the results of individual determinations on each of the subjects throughout the experiment, except for subjects who were unable to collect specimens before 20R. Table 2 shows the mean values in 12 men from whom two specimens were collected 5 days apart. In Tables 3 and 4 are listed respectively the mean values of determinations in the total group and in the group of four subjects whose last semen specimens were collected after 57 weeks of rehabilitation. Standard deviations are not given because the data depart widely from a normal probability distribution. The mean values are presented only for what they are worth and can be compared with reservation to values accepted as normal for each category. Normal value ranges are included in each table for comparison. There is marked deviation in response of individual subjects to ~emi starvation and to rehabilitation, as stated above. In some instances these variations are doubtless due to errors in observations. In others, unknown biologic factors probably account for the deviations. Some of these variations have been discussed, but it does not appear practical to take up each one individually. A comparison of the specimens collected 5 days apart (Table 2) showed
TABLE l.
..,
Co>
Data on Semen Studies
.....
pH
Count (million / cc.)
Total sperm (million/ ejac)
7-8 8 8 7 7
40 -300 25.0 25.0 105.0 65.0
80 -1000 2.5 5.0 42.8 117.0
70 OR MORE 51.0 55.0 72.1 70.5
3.9
65.5
30
1+
8.0
80 50
2+ 2+
24.0 24.0
Longevity (hr.)
Date
E.c.
24S 25S 6R 11R
2-5 0.1 0.2 0.4 1.8
C.F.
24S 25S 6R 11R
0.1 0.1 0.3 0.4
2+ 2+ 2+ 2+
2+ 1+ 3+ 3+
6 6 7 8
160.0 495.0
48.0 198.0
82.6 76.5
S.B.L.
24S 25S 6R 11R
0.5 0.2 0.35 1.1
3+ 2+ 1+ 2+
4+ 3+ 1+ 1+
7 8 8 8
1500.0 180.0 16.5 2.5
750.0 36.0 5.8 2.8
66.2 71.7 81.0 72.4
P. L.
25S 6R 11R 20R 57R
3.5 4.0 5.0 4.5 7.0
2+ 3+ 1+ 3+ 2+
4+ 3+ 3+ 2+ 2+
8 7 8 8
730.0 340.0 62.5 70.0 150.0
2555.0 1360.0 312.5 315.0 1050.0
68.1 71.4 88.0 67.0 76.0
30 50 60 60 90
2+ 3+ 2+ 2+ 3+
7.5 18.5 24.0 32.0 24.0+
24S 6R 11R
0.45 0.9 5.0
2+ 3+ 3+
3+ 3+ 3+
7 7 7
745.0 770.0 105.0
335.3 693.0 525.0
56.3 56.8 55.8
80 80 90
3+ 3+ 3+
12.0 24.0 31.0
24S 25S
0.2 0.35
2+ 4+
6 7
Subject
NORMAL RANGE
R.T.L.
R.T.M.
Viscosity
Turbidity
2+ -3+ 2+ -3+ 1+ 1+ 1+ 1+ 3+ 2+ 2+ 2+
2+ 2+
39.0
% Morphology (% normal) Motile
Quality of motility
Volume (cc.)
60 OR MORE 2+ -3+ 60 2+ 30 1+ 30 2+
24 OR MORE 7.5 7.5 6.0
qns J:
c: 0-
~ m
~
'T1
.,
CD
'< I/O III
.,CD
630.0
220.5
51.7
30
2+
5.0
-
'<
<
0
Subject
Date
Volume (cc.)
Viscosity
Turbidity
pH
Count (million/ cc.)
Total sperm (million/ ejac)
NORMAL
7-8 7 7
MORE
~
53.5 76.0 79.5 79.0
30 40 25 90
2+ 2+ 2+ 3+
7.0 20.0 23.0 24.0+
120.0 90.0 72.0 20.0
360.0 225.0 165.6 44.0
49.8 57.7 60.8 77.5
30 10 50 15
2+ 1+ 3+ 2+
7.0 3.0 16.0 13.0
340.0 292.5 30.0 35.0
1190.0 1023.8 135.0 245.0
69.2 82.0 64.1 71.5
40 40 80 60
2+ 2+ 3+ 2+
4.5 24.0 36.0 24.0+
7 7 7 7
1470.0 2710.0 1780.0 255.0
441.0 813.0 267.0 229.5
79.5 76.8 73.7 80.5
70 40 10 50
3+ 2+ 2+ 2+
8.0 5.5 19.0 17.0
8 8 8
355.0 200.0 500.0
710.0 280.0 1050.0
54.9 64.0 81.5
20 50 10
2+ 2+ 1+
7.0 7.0 15.0
2+ 3+ 2+ 2+
4+ 3+ 3+ 3+
7 7 7
24S 25S 6R 11R
3.0 2.5 2.3 2.2
1+ 2+ 2+ 2+
2+ 4+ 3+ 2+
8 7 7 7
25S 11R 20R 57R
3.5 3.5 4.5 7.0
2+ 2+ 3+ 3+
4+ 3+ 2+ 3+
7 7 7
D.J.P.
24S 25S 6R 11R
0.3 0.3 0.15 0.9
3+ 3+ 3+ 3+
4+ 4+ 3+ 3+
W.R.
24S 25S 11R
2.0 1.4 2.1
2+ 2+ 2+
3+ 3+ 3+
R. M.
1220.0 795.0 130.0 200.0
MORE
24 OR
3660.0 3577.5 715.0 1900.0
3.0 4.5 5.5 9.5
L.W.M.
80 -1000 227.5 161.0 210.0
60 OR
!"
90 100 80
25S 6R 11R 57R
W.T.M.
40 - 300 175.0 70.0 60.0
70 OR
z0
Longevity (hr.)
88.5 78.5 87.5
11R 20R 57R
2+ -3+ 2+ -3+ 3+ 1+ 2+ 3+ 2+ 1+
% Morphology (% normal) Motile
2+ -3+ 3+ 3+ 3+
2-5 1.3 2.3 3.5
RANGE
.!"
Quality of motility
:;;
MORE
23.0 34.0 24.0+
UI
m
;:
....UI
>
'" <
>
::
0
z >
z 0
:I:
c ;:
>
z
UI
m
;: m
z
'".......,
w
TABLE 1.-CContinuedJ
pH
Count (million/ cc.)
Total sperm (million/ ejac)
7-8 7 7 7 7
40 -300 165.0 75.0 230.0 27.5
80 - 1000 825.0 420.0 1495.0 109.0
Date
Volume (cc.)
W.S.
24S 25S 6R 11R
2-5 5.0 5.6 6.5 4.0
R.S.
24S 25S 6R 11R 20R
1.1 0.9 1.8 1.5 6.0
2+ 2+ 2+ 2+ 3+
4+ 4+ 3+ 2+ 3+
7 8 7 7 7
430.0 730.0 320.0 100.0 25.0
24S 25S 6R 11R
0.2 0.4 0.2 1.6
3+ 4+ 2+ 3+
3+ 3+ 2+ 1+
7 8 8 7
24S 25S 6R 11R 20R
1.7 1.0 1.3 3.0 2.5
1+ 2+ 1+ 2+ 2+
3+ 2+ 1+ 3+ 2+
24S 25S 6R 11R 20R
0.5 0.1 0.7 0.5 4.5
2+ 2+ 2+ 2+ 1+
3+ 2+ 2+ 2+ 2+
Subject
Viscosity
Turbidity
IV
a-
NORMAL RANGE
M.S.
K.D.T.
C.W.
2+ -3+ 2+ -3+ 2+ 3+ 1+ 1+ 3+ 3+ 2+ 2+
% Morphology (% normal) Motile
700B
60 OR
MORE
MORE
Quality of motility
Longevity (hr.)
24 OR
71.7 72.0 66.3 79.0
60 30 20 50
2+ -3+ 3+ 1+ 1+ 2+
473.0 657.0 576.0 150.0 150.0
85.3 70.0 69.0 72.0 86.5
90 20 75 50 90
3+ 1+ 2+ 3+ 3+
4.5 7.0 24.5 15.5 35.0
367.0 1410.0 750.0 80.0
73.4 564.0 150.0 128.0
71.5 60.5 81.9 74.5
20 5
2+ 1+
5.0 4.5
5
1+
6.0
8 8 8 8 7
120.0 105.0 130.0 17.5 1.0
204.0 105.0 169.0 52.5 2.5
84.3 71.5 75.2 67.0 75.2
10 30 50 40 90
1+ 2+ 2+ 2+ 3+
4.5 6.5 14.5 13.3 32.0
7 8 7 7 7
96.0 195.0 74.0 158.0 2.0
48.0 19.5 51.8 79.0 9.0
68.0 69.0 72.1 78.0 79.0
20 10 20 25 15
1+ 1+ 2+ 1+ 2+
7.5 6.0 11.0 19.5 30.0
MORE
6.0 7.8 23.5 23.0
::t:
c .... ~ m
."
CD ~
-< I/O U> CD ~
-<
--
"
'" TABLE 2.
Date
"'
% Motility
Longevity (hr.)
Morphology (% normal)
388.7 312.5
34.2 21.3
5.3 5.0
68.0 67.1
80-1000
60 or more
24 or more
70 or more
Volume (ee.)
Count (million/ ee.)
Total sperm (million/e;ae)
1.2 1.4
464.8 572.0
2-5
40-300
7-24-45 7-29-45 NORMAL RANGE
< 0
Average of Semen Factors in 12 Men at 5-Day Intervals in the Twenty-fourth Week of Semistarvation
!'> Z
? !"
:;;
-'" (J)
TABLE 3.
Week
24S 6R llR 20R NORMAL RANGE
m
Average Semen Factors in Total Group of Subjects
~ (J)
Number of sub;ects
Volume ( ee.)
Count (million/ ee.)
Total (million/ e;ae)
16 13 16 6
1.6 1.8 2.4 4.2
514.8 426.3 158.7 43.3
2-5
40-300
% Motile
Longevity (hr.)
Morphology (% normal)
775.4 661.2 264.2 185.4
36.9 38.8 34.0 75.0
5.4 15.1 16.6 33.0
65.9 72.2 77.8 71.8
80-1000
60 or more
24 or more
70 or more
.... >
'" < > ::: 0
z > z c
::t C ~
> z TABLE 4.
Average Semen Factors in Four Subjects in Whom Specimens Were Available at Fifty-seventh Week of Rehabilitation
Week
24S 6R llR 20R 57R NORMAL RANGE
(J)
m ~ m
Volume (ee.)
Count (million/ ee.)
Total sperm (million/ eiae)
% Motile
Longevity (hr.)
Morphology (% normal)
2.5 3.0 3.8 3.8 6.8
730.0 568.0 165.0 56.7 111.3
2,468.4 2,468.7 569.7 203.7 851.3
33.3 45.0 47.5 80.0 80.0
4.8 19.0 20.8 25.5 over 24
63.6 73.7 84.5 69.9 78.5
2-5
40-300
80-1000
60 or more
24 or more
70 or more
z
w
to.> '01
328
HULME
[Fertility & Sterility
no significant difference between the mean values. The lower percentage motility in the second sample is of doubtful significance. This tends to indicate that starvation does not retard the ability of the male generative tract to restore semen to its original quality if a rest period is allowed between ejaculations. The viscosity, turbidity, and pH of semen specimens showed no characteristic change at the end of semistarvation or during rehabilitation. At the end of semistarvation (24S) the mean values for all major items were beyond values generally considered normal (Table 3). The mean volume of ejaculate at 24S was 1.6 cc. Eleven of the 16 specimens were 2.0 cc. or less. During rehabilitation the mean volume returned to normal range some time between the eleventh and twentieth week. At llR only 8 specimens were below 2.0 cc. and at 20R all were greater than 2.0 cc. in volume. The mean spermatozoa count in millions per cubic centimeter and the mean total spermatozoa count were both found to be markedly elevated at the end of semistarvation. The variation in values in these items among the subjects was greater than in any other. One subject showed no spermatozoa at the end of semistarvation, but later had normal values. Only 3 subjects (E.c., C.F., RT.M.) produced fewer than 40 million spermatozoa per cubic centimeter and most of them ranged unusually high. The high spermatozoa count may be accounted for, at least in part, by the low volume of the corresponding specimens, resulting in relative concentration of the spermatozoa. This is shown by the relatively low total spermatozoa in the ejaculate. This does not explain the findings in W.T.M., however, who produced 1200 million spermatozoa per cubic centimeter in a volume of 3.0 cc., or a total of 3660 million spermatozoa per ejaculate. His values, and the fact that he showed consistently high spermatozoa production throughout rehabilitation, must be attributed to an exceedingly fruitful set of seminiferous tubules. At the end of semistarvation the mean spermatozoa count was elevated. Through rehabilitation the count diminished, reaching normal ranges at about 11 weeks (llR). After 11 weeks of rehabilitation, 5 subjects showed spermatozoa counts lower than 40 million per cubic centimeter. Four specimens (RM., RS., K.D.T., C.W.) were also deficient in spermatozoa after 20 weeks of rehabilitation. The mean percentage of motile spermatozoa was far below normal at the end of semistarvation. Only 2 of the 16 specimens showed more than 70 per
Vol. 2, No.4, 1951]
SEMISTARVATION AND HUMAN SEMEN
329
cent of the spermatozoa to be motile. In contrast to most of the other semen factors, the motility did not begin to increase markedly until after 11 weeks of rehabilitation. The percentage of motility was apparently normal at 20 weeks of rehabilitation (20R). The percentage of motility remained low or absent in several individuals, even after rehabilitation. Most notable are subjects E.G, S.B.L., and M.S. It is difficult to account for this factor. These subjects all showed low volume of semen, and the absence of motility at three hours after collection may be due to malfunction of the prostate and/or seminal vesicles, resulting in absence of proper substrate for motility of the spermatozoa. Semistarvation may have resulted in interference with spermatogenesis to the point that the spermatozoa are rendered incapable of responding to stimulation to motility. S.B.L., particularly, is notable in absence of motility in every specimen studied. The longevity of the spermatozoa was also drastically reduced at the end of semistarvation. In every subject the spermatozoa ceased activity long before twenty-four hours. This factor, along with the motility, was retarded in returning to normal during rehabilitation. In most instances, the spermatozoa lived twenty-four hours or longer after 11 weeks and none were below this level at the end of 20 weeks of rehabilitation. The percentage of normal spermatozoa (morphology) was not markedly affected by semistarvation. There was no great change over the period of rehabilitation. The most common abnormality encountered at the end of semistarvation was one in which the tail was tightly coiled about the head of the spermatozoon and the whole structure encased in protoplasm which had not yet been cast off the spermatozoon. This was interpreted as being an immature or incompletely developed spermatozoon. Table 4 shows in general the same values and same trends throughout rehabilitation as those in Tables 1 and 3.
SUMMARY The literature has been reviewed pertaining to the effect of starvation on testicular morphology and semen with a few references to psychosexual changes in starvation. Semen specimens were collected from 16 men who had undergone semistarvation for a period of 24 weeks. Twelve of these men submitted a second specimen 5 days after the :Srst. Specimens were also collected after 6, 11,
330
HULME
[Fertility & Sterility
and 20 weeks of dietary rehabilitation and on 4 subjects after 57 weeks of rehabilitation. All specimens were analyzed by routine methods. The following conclusions can be drawn from this study: 1. Semistarvation of normal men produces marked loss of interest in sex and diminution in sexual function. 2. Semen produced by subjects who have undergone semistarvation exhibits profound changes from normal characteristics. The volume of ejaculate is lower than normal, as are the motility and longevity of spermatozoa. The spermatozoa count is above normal at first. It later drops to normal and below normal in individual instances. There is no demonstrable change in viscosity, turbidity, pH, or morphology. 3. In semistarvation, there is no loss of the normal generative tract capacity to produce a second semen specimen of the same quality as one produced 5 days previously. 4. Sex interest, sexual function, and semen qualities return to normal after 11 to 20 weeks of adequate nourishment. The psychologic aspects of sexual functions return more slowly than semen factors. REFERENCES 1. Beeli, S. S.: Report in Jackson, C. M., Inanition and Malnutrition. Philadelphia, The Blakiston Company, 1925. 2. Cordes, H.: Arch. f. path. Anat. 151:402, 1898. 3. Hausemann, D. V.: Arch. f. Anat. u. PhysioI. p. 176, 1896. 4. Hibbs, R E.: Am. J. M. Sc. 213:176, 1947. 5. Hotchkiss, R. S.: Fertility in Men. Philadelphia, J. B. Lippincott Co., 1944, pp. 102-134. 6. Jackson, C. M.: Inanition and Malnutrition. Philadelphia, The Blakiston Company, 1925. 7. Jacobs, E.: J. Clin. Endocrinol. 8:227, 1948. 8. Keys, A., and others: Biology of Human Starvation. Minneapolis, University of Minnesota Press, 1950. 9. Klatskin, W., and others: Am. J. M. Sc. 213:19,1947. 10. Krieger, M.: Ztschr. f. ang. Anat. 7:87, 1920. 11. L'Amy, M., Lamotte, M., and Lamotte-Barillon, S.: Bull. et memo Soc. med d. hOp. de Paris. 62:435, 1946. 12. Menze, W.: EndokrinoI. 24:159, 1941. 13. Michelson, L.: Unpublished data. 14. Miles, W. R.: J. Nerv. & Ment. Dis. 49:208, 1919. 15. Moore, C. R., and Samuels, L. T.: Am. J. Physiol. 96:278, 1931. 16. Morgulis, S., Howe, P. E., and Hawk, P. B.: BioI. Bull. 28:397, 1915. 17. Mulinos, M. G., and Pomerantz, L.: J. Nutrition 19:493,1940. 18. Mulinos, M. G., and Pomerantz, L.: Endocrinology 29:267, 1941. 19. Nicolaeff, P.: Presse med. 31:1007, 1923. 20. Pazos, R, Jr., and Huggins, c.: Endocrinology 36:416, 1945.
I
Vol. 2, No.4, 1951]
SEMISTARVATION AND HUMAN SEMEN
331
21. Poiarkov, E. L.: Compt. rend. Soc. de bioI. 74:141, 1913. 22. Reach, F.: Wien. klin. Wchnschr. 31:1249, 1918. 23. Rubner, R.: Report in Reichsgesundheitsrat, December 20, 1917. Abstract, Mil, Surgeon 45:237, 1919. 24. Simmonds, M., in Aschoff, L.: Pathologische Anatomie. Jena, Gustav Fischer, vol. 2. 25. Siperstein, D. M.: Anat. Rec. 20:355, 1921. 26. Stefko: Rev. Franc. d'Endocrinol. 6:103, 1928.
Inaugural Meeting: Sociedade Brasileira de Esterilidade The Brazilian Sterility Society will hold its first meeting at the Hotel Gloria in Rio de Janeiro from October 14-19, 1951. Some sixty eminent contributors to the study and treatment of infertility have been invited to speak. The tentative program covers all phases of the subject from the academic to the clinical. Among the many topics discussed will be the physiology and pathology of spermatogenesis, ovulation, fertilization, and nidation; the endometrial cycle, the Rh factor, abortion; standard diagnostic procedures in the male and female, investigation of cervical, tubal, and ovarian function, and finally, the planning of a medical program to prevent and treat sterility on a nationwide basis. Detailed information about the convention may be obtained from the President, Dr. A. Campos da Paz, Filho, Avenida Mem de Sa, 197, Rio de Janeiro, Brazil.