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Fibrinolysis and coagulation markers in seminal plasma before and after vasectomy
Fibrimlysis (1993) @2993 Longman
7, 135-138
GroupUK
Ltd
Fibrinolysis and Coagulation Markers in Seminal Plasma Before and After Vasectomy
J. W. J. van Wersch, J. H. M. Ubachs, K. P. J. Delaere SUMMARY. Two groups of patients have been evaluated before (n=SO) and after (n=87) vasectomy to assess the eventual presence of haemostasis markers in seminal plasma and if so whether there is an effect of vasectomy on coagulation and fibrinolysis markers. We found thrombin-antithrombin III, prothrombin fragment 1.2, tissue plasminogen activator activity and D-dimer concentrations in well measurable concentrations and calculated the D-Dimer/thrombin-antithrombin III ratios as arbitrary measures for the setting of the fibrinolysis/coagulation balance. Comparing the concentrations of these parameters we found no significant shift after vasectomy for thrombin-antithrombin III, prothrombin fragment 1.2 and tissue plasminogen activator activity. The D-dimer concentrations and the D-dimer/thrombin-antithrombin III ratios however were significantly lower in the postvasectomy group, which suggests a reduction of the fibrinolytic activity. This is a first report on the presence of these haemostasis markers in seminal plasma and we conclude that alterations in the fibrinolysis/coagulation balance occur, which are associated with vasectomy. The meaning of this tinding is however still unclear.
INTRODUCTION
METHODS
There are concerns about the side-effects of vasectomy for the human testis. These have been summarized recently by McDonald.’ Besides the suspicion of accelerated testicular and prostatic tumour growth after vasectomy,2-5 several other worries can be mentioned, such as irreversibility,“s predisposition to cardiovascular disease,‘,‘” abnormalities in testicular biopsy specimens in some men after vasectomy, ‘l-l7 raised intraluminal pressure with dilatation of seminiferous tubules,‘6*‘7 antisperm antibody formation’8~‘9 and finally, impairment of the endocrine function of the human testis.2s27 In this study the presence of several coagulation and fibrinolysis markers in seminal plasma has been investigated as well as the changes in these parameters after vasectomy. For this aim we determined the thrombin-antithrombin III complex (TAT-III), prothrombin fragment 1.2, tissue plasminogen activator actitity (t-PAact) and the D-dimers. Moreover, we calculated the D-dimer/thrombin-antithrombin III ratio as an arbitrary measure for the positioning of the fibrinolysis/coagulation balance.
For the TAT-III determinations, an ELISA test kit (Behring Corp. Marburg, Germany) was used. The prothrombin fragment 1.2 was determined with the Enzygnost@ F 1.2 of Behring Corp. (Marburg, Germany). Fibrin degradation products were measured by means of the D-dimer test (Boehringer Mannheim, Mannheim, Germany). The D-dimer test is a specific ELISA test for the determination of degradation products of cross-linked fibrin only and not of fibrinogen. Tissue plasminogen activator (t-PA) was quantitated by measuring the enzymatic activity of the plasmin generated towards the synthetic substrate S-2251 (Kabi Vitrum Diagnostica, Molndal, Sweden) in the presence of fibrinogen fragments as t-PA stimulators according to the following principle:
+t-PA+t-PA
stimulator + plasmin
1. Plasminogen plasmin 2. Substrate S-2251
??
tri-peptide+p-nitroanilin
The reaction product p-nitroanilin can be measured spectrophotometrically at a wave length of 405nm.
J. W. J. van Wersch,
J. H. M. Uhachs, K. P. J. Delaere, Departments of Haematology, Gynaecology, Urology, De Wever Hospital, P.O. Box 4446,640l CX Heerlen, The Netherlands. 135
136 Fibrinolysis and Coagulation Markers in Seminal Plasma Before and After Vasectomy
PATIENTS There were two groups of patients: group I with 80 patients before vasectomy, group II with 87 patients after vasectomy. To have a reference for the values of the seminal plasma we analysed the same parameters in blood plasma in a group of 80 age-matched healthy male individuals.
SAMPLES The semen was obtained at home after masturbation and collected in graduated tubes, which had to be presented at the laboratory within 1 h after the production. The semen was centrifuged (2OOOXgat room temperature, 10min) and the supernatant collected. It was then deep frozen at -70°C until the next series of measurements. Venous blood was collected between 08:30-09:00 in citrate (0.11 mol/l) containing tubes (nine volumes blood plus one volume citrate). Citrated plasma was prepared by centrifugation of the titrated blood for 10min at 25°C (16OOXg).
STATISTICAL ANALYSIS
The median thrombin-antithrombin III values were higher after vasectomy (4.6 vs 3.0&l) but not significantly different. After vasectomy (4.6&l) they were significantly higher than the median value in blood plasma (2.4l.@; p
DISCUSSION
The Mann-Whitney-U test was employed comparison of the patient groups.
for the
RESULTS The basic statistical data of the used parameters in seminal plasma and blood plasma are summarized in Table 1.
Semen forms a so-called coagulum immediately after ejaculation and liquefies after 5 to 20min.*’ The coagulum is composed of fibrin-like material29 which, however, has sparely been examined in relation to the components of the classical haemostasis system. Regarding the fibrinolysis system it is known that t-PAact-urokinase and plasminogen activator inhibitor are resent in human seminal fluid and in spermatozoa.3R38
Table 1 Summary of the median results and interquartile
ranges (IR) in blood plasma and in seminal plasma of the patient groups before (group I) and after (group II) vasectomy ‘) significance level group I vs II p
Groups
Seminal plasma, before vasectomy (Group I, n=80)
Seminal plasma, after vasectomy (Group II, n=87)
Blood plasma (n=l30)
Parameters
Median (IR)
Median (IR)
Median (IR)
4.6 (7.7) 0.55 (0.26)
2.4” (1.4) 0.66 (0.36)
102” (178) 20.02) (28.2)
WY) (146)
TAT-III (@I) (Z) Prothrombin fragment 1.2 (nmol/I)
0.42 (0.34)
D-dimer (&I)
140’) (303) 33.32’ (46.0) 211 (256)
D-dimer/TAT-III
ratio
t-PA activity (X l@IU/l)
186 (197)
705’ (47) 1.5@ (1.0)
Fibrinolysis
Inasmuch as the coagulation markers are concerned the number of reports is limited. A kallikreinlike serine protease (one of the activators of the intrinsic coagulation) has been described in prostatic fluid.39 Platelet-activating factor-like activity, a potent phospholipid with a wide spectrum of biological activities such as activation of the coagulation system, 40 is found in human spermatozoa.41 High concentrations of protein C inhibitor have been reported by Laurel1 et aL4* whereas earlier evidence for fibrin cross-linking activity was found in guinea pigs43 and rats.44 In this study we have demonstrated that besides t-PA turn-over products of the regular coagulation and fibrinolysis system such as TAT-III, prothrombin fragment 1.2 and D-dimer were well measurable in the seminal plasma, thus reflecting the functional presence of coagulation and fibrinolysis. The seminal concentrations of TAT-III and t-PA were significantly higher than in blood plasma both before and after vasectomy. The extremely high activities of t-PA have also been reported by others.29 The D-dimer values as well as the D-dimer/TAT-III ratios were significantly lower than those in blood plasma. The seminal prothrombin fragment 1.2 concentrations were in the same range as those of the blood plasma. Comparison of the vasectomy groups showed that the TAT-III and prothrombin fragment 1.2 values in the postvasectomy group were higher (but not significantly) than those in the prevasectomy group. The fibrinolysis marker (D-dimer) on the other hand was significantly reduced after vasectomy and so was the D-dimer/TAT-111 ratio as well in comparison with the prevasectomy values. No significant difference for the investigated parameters and for the D-dimer/TAT-III ratios was found in the postvasectomy group 6 weeks and 4 months after vasectomy (not shown in the results). This observation excludes the possibility that the alterations of the several variables have been caused by time or by the surgical procedure itself. We are aware of the rather large dispersion of the values and that there might be some bias caused by the nature of the seminal plasma itself and by the processing of the specimens. But, the decreases in D-dimer and D-dimer/TAT-III ratio were so great that they must be primarily due to the effects of coagulation activation and fibrinolysis reduction after vasectomy and that the fibrinolysis level did seem not to keep step with the coagulation activation. We conclude that the results of this study show that haemostasis (turn-over) products are present in seminal plasma and that alterations in these analytes’ concentrations occur after vasectomy. The haemostatic balance points into the direction of coagulation activation and of fibrinolysis reduction. The presented findings should encourage further studies in this field to clarify the meaning of the presence of these haemostasis markers in seminal plasma and should eventually be taken into account when
attempting vasectomy.
to explain earlier
described
137
effects of
REFERENCES 1. McDonald S W. Vasectomy and the human testis. Br Med J 1990; 301: 618-619. 2. Cale A R J, Faronk M, Prescott R J, Wallace I W J. Does vasectomy accelerate testicular tumour? Importance of testicular examinations before and after vasectomy. Br Med J 1990; 300: 370. 3. Thornhill J A, Butler M, Fitzpatrick J M. Could vasectomy accelerate testicular cancer? The importance of prevasectomy examination. Br J Urol 1987; 59: 367. 4. Mettlin C, Natarajan N, Huben R. Vasectomy and prostate cancer risk. Am J Epidemiol 1990; 32: 1056-1061. 5. Rosenberg, L, Palmer J R, Zauber A G, Warshauer M E, Stolley P D, Shapiro S. Vasectomy and the risk of prostate cancer. Am J Epidemiol 1990; 132: 1051-1055. 6. Silber S J. Vasectomy and vasectomy reversal. Fertil Steril 1978; 29: 125-140. 7. Linnet L, Hjort T, Fogh-Anderson P. Association between failure to impregnate after vasovasotomy and spermagglutinins in semen. Lancet 1981; i: 117-119. 8. Fuchs E F, Alexander N J. Immunologic consideration before and after vasovasotomy. Fertil Steril 1983; 40: 497-499. 9. Clarkson T B, Alexander N J. Long-term vasectomy: effects on the occurrence and extent of atherosclerosis in the rhesus monkey. J Clin Invest 1980; 65: 15-25. 10. Campbell W B. Vasectomy and arterial disease. J R Sot Med 1988; 81: 683-685. 11. Derrick F C, Clover W L, Kanjuparamban Z et al. Histological changes in the seminiferous tubules after vasectomy. Fertil Steril 1974; 25: 649-658. 12. Gupta A S, Kothari L K, Dhmva A, Bapna R. Surgical sterilization by vasectomy and its effect on structure and function of the testis in men. Br J Surg 1975; 62: 59-63. 13. Fallon F, Jacob0 L. Bunae R E. Restoration of fertilitv, bv< vasovasotomy. J Urol 1978; 119: 85-86. 14. Jenkins J P, Muir V Y, Blacklock N J, Turk J L, Hanley H G. Consequences of vasectomy: an immunologic and histological study related to subsequent fertility. Br J Urol 1979; 31: 406-410. 15. Bigazzi P E, Alexander N J, Silber S S. Studies on testicular biopsies from Vasectomized men. In: Lepow I H, Crozier R, eds. Vasectomy: immunologic and pathophysiologic effects in animals and man. New York: Academic Press, 1979; 459-469. 16. Jarow J P, Budin R E, Dym M, Zirken B R, Noren S, Marshall F F. Quantitative pathologic changes in the human testis after vasectomy. A controlled study. N Engl J Med 1985; 313: 1252-1256. 17. Mehrotra R, Nath P, Singh K M et al. Changes in seminiferous tubules after vasectomy. Indian J Pathol Microbial 1985; 28: 371-378. 18. Samuel T, Kolk A H J, Rumke P, van Lis J M J. Autoimmunity to sperm antigens in vasectomized men. Clin Exp Immunol 1975; 21: 65-74. 19. Ansbacher R, Hodge P, Williams A, Mumford D M. Vas ligation, humoral sperm antibodies. Int J Fert 1976; 21: 258-260. 20. Rosemberg E, Marks S C, Howard P J, James L P. Serum levels of follicle stimulating and luteinizing hormones before and after vasectomy in men. J Urol 1974; 111: 626-629. 21. Kobrinsky N L, Winter J S D, Reyes F I, Fairman C. Endocrine effects of vasectomy in men. Fertil Steril 1976; 21: 152-156. 22. Naik V K, Thakur A N, Sheth A R et al. The effect of vasectomy on pituitary-gonadal function in men. J Reprod Fertil 1976; 48: 441-442. 23. Smith K D, Tcholakian R K, Chowdhury M, Hai B P. Endocrine studies in vasectomized men. In: Lepow I H, Crozier R, eds. Vasectomy: immunologic and
138 Fibrinolysis and Coagulation Markers in Seminal Plasma Before and After Vasectomy
24. 25.
26.
27. 28.
29. 30.
31.
32.
33.
pathophysiologic effects in animals and man. New York: Academic Press, 1979; 183-200. Whitby R M, Gordon R D, Blair B R. The endocrine effects of vasectomy: a prospective five-year study. Fertil Steril 1979; 31: 518-520. Goebelsmann U, Bernstein G S, Gale J A et al. Serum gonadotrophin, testosterone, estradiol, and estrone levels prior to and following bilateral vasectomy. In: Lepow I H, Crozier R, eds. Vasectomy: immunologic and pathophysiologic effects in animals and man. New York: Academic Press, 1979; 165-181. Varma M M, Varma R R, Johanson A J, Kowarski A, Migeon C J. Lond-term effects of vasectomy on pituitarygonadal function in man. J Clin Endocrinol Metab 1975; 40: 868-871. Skegg D C G, Mathews J D, Guillebaud J et al. Hormonal assessment before and after vasectomy. Br Med J 1976; i: 621-622. Mandal A, Bhattacharyya A K. Grouping the ejaculates according to the degree of coagulation and the relationship to the levels of choline and cholinesterase. Int J Androl 1986; 9: 407-415. Polak B, Daunter B. Seminal plasma biochemistry. IV: enzymes involved in the liquefaction of human seminal nlasma. Int J Androl 1989: 12: 187-194. Suominen J, Niemi N. Proteolytic enzymes in human seminal fluid. Stand J Clin Lab Invest 1970; 25, suppl. 113: 52 (abstract). van Dreden P, Gonzalez J, Poirot C. Human seminal fibrinolytic activity: specific determinations of tissue plasminogen activator and urokinase. Andrologia 1991; 23(l): 29-33. Astedt B, Wallen P, Aasted B. Occurrence of both urokinase and tissue plasminogen activator in human seminal plasma. Thromb Res 1979; 16(3-4): 463-472. Kruithof E K, Tran-Thang C, Ransijn A, Bachmann F. Demonstration of a fast-acting inhibitor of plasminogen activators in human plasma. Blood 1984; 64(4): 907-913.
Received: 23 March 1992 Accepted after revision: 17 October 1992 Offprint orders to: J. W. J. van Wersch, Department of Haematology, De Wever Hospital, P.O. Box 4446,640l CX Heerlen, The Netherlands.
34. ProPPina D, Zaneveld L J, Tauber P F, Schumacher G F. Purif;caGon of plasminogen activators from human seminal olasma. Biochem J 1978: 171(2): 435-444. 35. Liedholm P, Astedt B. Fibrinolytic activity of the male reproductive organs in man. Stand J Urol Nephrol 1973; 81-86. 36. Rijken D C, Wijngaards G, Welbergen J. Immunological characterization of plasminogen activator activities in human tissues and body fluids. J Lab Clin Med 1981; 477-486. 37. Christ G, Binder B R. Components of the fibrinolytic system in spermatozoa and seminal plasma of fertile and infertile men. Thromb Haemost 1989; 62: 396 (abstract). 38. Maier U, Kirchheimer J C, Hienert G, Christ G, Binder B R. Fibrinolytic parameters in spermatozoas and seminal plasma. J Urol 1991; 146: 906-908. 39. Lilja H. A kallikrein-like protease in prostatic fluid cleaves the predominant seminal vesicle protein. J Clin Invest 1985; 76: 18991903. 40. Kumar R, Hanahan D J. Diversity of the biochemical and biological behavior of platelet activating factor. In: Snyder F, ed. Platelet activating factor. New York: Plenum Press; 1987 p. 239. 41. Minhas B S, Kumar R, Ricker D D, Robertson J L, Dodson M G. The presence of platelet-activating factor-like activity in human spermatozoa. Fertil Steril 1991; 55: 372-376. 42. Laurel1 M, Christensson A, Abrahamsson P A, Stenflo J, Lilja H. Protein C inhibitor is present at micromolar concentrations in seminal plasma. Thromb Haemost 1991; 65: 854 (abstract). 43. Williams-Ashman H G, Notides A C, Pabalan S S, Lorand L. Transaminase reactions involved in the enzymatic coagulation of semen: isolation of gamma-glutamyl-e-lysine dipeptide from clotted secretion protein of guinea pig seminal vesicle. Proc Natl Acad Sci USA 1972; 69: 23222325. 44. Williams-Ashman H G, Wilson J, Beil R E, Lorand L. Transglutaminase reactions associated with the rat semen clotting system: modulation by macromolecular polyanions. Biophys Res Commun 1977; 79: 1192-1198.
7, 135-138
GroupUK
Ltd
Fibrinolysis and Coagulation Markers in Seminal Plasma Before and After Vasectomy
J. W. J. van Wersch, J. H. M. Ubachs, K. P. J. Delaere SUMMARY. Two groups of patients have been evaluated before (n=SO) and after (n=87) vasectomy to assess the eventual presence of haemostasis markers in seminal plasma and if so whether there is an effect of vasectomy on coagulation and fibrinolysis markers. We found thrombin-antithrombin III, prothrombin fragment 1.2, tissue plasminogen activator activity and D-dimer concentrations in well measurable concentrations and calculated the D-Dimer/thrombin-antithrombin III ratios as arbitrary measures for the setting of the fibrinolysis/coagulation balance. Comparing the concentrations of these parameters we found no significant shift after vasectomy for thrombin-antithrombin III, prothrombin fragment 1.2 and tissue plasminogen activator activity. The D-dimer concentrations and the D-dimer/thrombin-antithrombin III ratios however were significantly lower in the postvasectomy group, which suggests a reduction of the fibrinolytic activity. This is a first report on the presence of these haemostasis markers in seminal plasma and we conclude that alterations in the fibrinolysis/coagulation balance occur, which are associated with vasectomy. The meaning of this tinding is however still unclear.
INTRODUCTION
METHODS
There are concerns about the side-effects of vasectomy for the human testis. These have been summarized recently by McDonald.’ Besides the suspicion of accelerated testicular and prostatic tumour growth after vasectomy,2-5 several other worries can be mentioned, such as irreversibility,“s predisposition to cardiovascular disease,‘,‘” abnormalities in testicular biopsy specimens in some men after vasectomy, ‘l-l7 raised intraluminal pressure with dilatation of seminiferous tubules,‘6*‘7 antisperm antibody formation’8~‘9 and finally, impairment of the endocrine function of the human testis.2s27 In this study the presence of several coagulation and fibrinolysis markers in seminal plasma has been investigated as well as the changes in these parameters after vasectomy. For this aim we determined the thrombin-antithrombin III complex (TAT-III), prothrombin fragment 1.2, tissue plasminogen activator actitity (t-PAact) and the D-dimers. Moreover, we calculated the D-dimer/thrombin-antithrombin III ratio as an arbitrary measure for the positioning of the fibrinolysis/coagulation balance.
For the TAT-III determinations, an ELISA test kit (Behring Corp. Marburg, Germany) was used. The prothrombin fragment 1.2 was determined with the Enzygnost@ F 1.2 of Behring Corp. (Marburg, Germany). Fibrin degradation products were measured by means of the D-dimer test (Boehringer Mannheim, Mannheim, Germany). The D-dimer test is a specific ELISA test for the determination of degradation products of cross-linked fibrin only and not of fibrinogen. Tissue plasminogen activator (t-PA) was quantitated by measuring the enzymatic activity of the plasmin generated towards the synthetic substrate S-2251 (Kabi Vitrum Diagnostica, Molndal, Sweden) in the presence of fibrinogen fragments as t-PA stimulators according to the following principle:
+t-PA+t-PA
stimulator + plasmin
1. Plasminogen plasmin 2. Substrate S-2251
??
tri-peptide+p-nitroanilin
The reaction product p-nitroanilin can be measured spectrophotometrically at a wave length of 405nm.
J. W. J. van Wersch,
J. H. M. Uhachs, K. P. J. Delaere, Departments of Haematology, Gynaecology, Urology, De Wever Hospital, P.O. Box 4446,640l CX Heerlen, The Netherlands. 135
136 Fibrinolysis and Coagulation Markers in Seminal Plasma Before and After Vasectomy
PATIENTS There were two groups of patients: group I with 80 patients before vasectomy, group II with 87 patients after vasectomy. To have a reference for the values of the seminal plasma we analysed the same parameters in blood plasma in a group of 80 age-matched healthy male individuals.
SAMPLES The semen was obtained at home after masturbation and collected in graduated tubes, which had to be presented at the laboratory within 1 h after the production. The semen was centrifuged (2OOOXgat room temperature, 10min) and the supernatant collected. It was then deep frozen at -70°C until the next series of measurements. Venous blood was collected between 08:30-09:00 in citrate (0.11 mol/l) containing tubes (nine volumes blood plus one volume citrate). Citrated plasma was prepared by centrifugation of the titrated blood for 10min at 25°C (16OOXg).
STATISTICAL ANALYSIS
The median thrombin-antithrombin III values were higher after vasectomy (4.6 vs 3.0&l) but not significantly different. After vasectomy (4.6&l) they were significantly higher than the median value in blood plasma (2.4l.@; p
DISCUSSION
The Mann-Whitney-U test was employed comparison of the patient groups.
for the
RESULTS The basic statistical data of the used parameters in seminal plasma and blood plasma are summarized in Table 1.
Semen forms a so-called coagulum immediately after ejaculation and liquefies after 5 to 20min.*’ The coagulum is composed of fibrin-like material29 which, however, has sparely been examined in relation to the components of the classical haemostasis system. Regarding the fibrinolysis system it is known that t-PAact-urokinase and plasminogen activator inhibitor are resent in human seminal fluid and in spermatozoa.3R38
Table 1 Summary of the median results and interquartile
ranges (IR) in blood plasma and in seminal plasma of the patient groups before (group I) and after (group II) vasectomy ‘) significance level group I vs II p
Groups
Seminal plasma, before vasectomy (Group I, n=80)
Seminal plasma, after vasectomy (Group II, n=87)
Blood plasma (n=l30)
Parameters
Median (IR)
Median (IR)
Median (IR)
4.6 (7.7) 0.55 (0.26)
2.4” (1.4) 0.66 (0.36)
102” (178) 20.02) (28.2)
WY) (146)
TAT-III (@I) (Z) Prothrombin fragment 1.2 (nmol/I)
0.42 (0.34)
D-dimer (&I)
140’) (303) 33.32’ (46.0) 211 (256)
D-dimer/TAT-III
ratio
t-PA activity (X l@IU/l)
186 (197)
705’ (47) 1.5@ (1.0)
Fibrinolysis
Inasmuch as the coagulation markers are concerned the number of reports is limited. A kallikreinlike serine protease (one of the activators of the intrinsic coagulation) has been described in prostatic fluid.39 Platelet-activating factor-like activity, a potent phospholipid with a wide spectrum of biological activities such as activation of the coagulation system, 40 is found in human spermatozoa.41 High concentrations of protein C inhibitor have been reported by Laurel1 et aL4* whereas earlier evidence for fibrin cross-linking activity was found in guinea pigs43 and rats.44 In this study we have demonstrated that besides t-PA turn-over products of the regular coagulation and fibrinolysis system such as TAT-III, prothrombin fragment 1.2 and D-dimer were well measurable in the seminal plasma, thus reflecting the functional presence of coagulation and fibrinolysis. The seminal concentrations of TAT-III and t-PA were significantly higher than in blood plasma both before and after vasectomy. The extremely high activities of t-PA have also been reported by others.29 The D-dimer values as well as the D-dimer/TAT-III ratios were significantly lower than those in blood plasma. The seminal prothrombin fragment 1.2 concentrations were in the same range as those of the blood plasma. Comparison of the vasectomy groups showed that the TAT-III and prothrombin fragment 1.2 values in the postvasectomy group were higher (but not significantly) than those in the prevasectomy group. The fibrinolysis marker (D-dimer) on the other hand was significantly reduced after vasectomy and so was the D-dimer/TAT-111 ratio as well in comparison with the prevasectomy values. No significant difference for the investigated parameters and for the D-dimer/TAT-III ratios was found in the postvasectomy group 6 weeks and 4 months after vasectomy (not shown in the results). This observation excludes the possibility that the alterations of the several variables have been caused by time or by the surgical procedure itself. We are aware of the rather large dispersion of the values and that there might be some bias caused by the nature of the seminal plasma itself and by the processing of the specimens. But, the decreases in D-dimer and D-dimer/TAT-III ratio were so great that they must be primarily due to the effects of coagulation activation and fibrinolysis reduction after vasectomy and that the fibrinolysis level did seem not to keep step with the coagulation activation. We conclude that the results of this study show that haemostasis (turn-over) products are present in seminal plasma and that alterations in these analytes’ concentrations occur after vasectomy. The haemostatic balance points into the direction of coagulation activation and of fibrinolysis reduction. The presented findings should encourage further studies in this field to clarify the meaning of the presence of these haemostasis markers in seminal plasma and should eventually be taken into account when
attempting vasectomy.
to explain earlier
described
137
effects of
REFERENCES 1. McDonald S W. Vasectomy and the human testis. Br Med J 1990; 301: 618-619. 2. Cale A R J, Faronk M, Prescott R J, Wallace I W J. Does vasectomy accelerate testicular tumour? Importance of testicular examinations before and after vasectomy. Br Med J 1990; 300: 370. 3. Thornhill J A, Butler M, Fitzpatrick J M. Could vasectomy accelerate testicular cancer? The importance of prevasectomy examination. Br J Urol 1987; 59: 367. 4. Mettlin C, Natarajan N, Huben R. Vasectomy and prostate cancer risk. Am J Epidemiol 1990; 32: 1056-1061. 5. Rosenberg, L, Palmer J R, Zauber A G, Warshauer M E, Stolley P D, Shapiro S. Vasectomy and the risk of prostate cancer. Am J Epidemiol 1990; 132: 1051-1055. 6. Silber S J. Vasectomy and vasectomy reversal. Fertil Steril 1978; 29: 125-140. 7. Linnet L, Hjort T, Fogh-Anderson P. Association between failure to impregnate after vasovasotomy and spermagglutinins in semen. Lancet 1981; i: 117-119. 8. Fuchs E F, Alexander N J. Immunologic consideration before and after vasovasotomy. Fertil Steril 1983; 40: 497-499. 9. Clarkson T B, Alexander N J. Long-term vasectomy: effects on the occurrence and extent of atherosclerosis in the rhesus monkey. J Clin Invest 1980; 65: 15-25. 10. Campbell W B. Vasectomy and arterial disease. J R Sot Med 1988; 81: 683-685. 11. Derrick F C, Clover W L, Kanjuparamban Z et al. Histological changes in the seminiferous tubules after vasectomy. Fertil Steril 1974; 25: 649-658. 12. Gupta A S, Kothari L K, Dhmva A, Bapna R. Surgical sterilization by vasectomy and its effect on structure and function of the testis in men. Br J Surg 1975; 62: 59-63. 13. Fallon F, Jacob0 L. Bunae R E. Restoration of fertilitv, bv< vasovasotomy. J Urol 1978; 119: 85-86. 14. Jenkins J P, Muir V Y, Blacklock N J, Turk J L, Hanley H G. Consequences of vasectomy: an immunologic and histological study related to subsequent fertility. Br J Urol 1979; 31: 406-410. 15. Bigazzi P E, Alexander N J, Silber S S. Studies on testicular biopsies from Vasectomized men. In: Lepow I H, Crozier R, eds. Vasectomy: immunologic and pathophysiologic effects in animals and man. New York: Academic Press, 1979; 459-469. 16. Jarow J P, Budin R E, Dym M, Zirken B R, Noren S, Marshall F F. Quantitative pathologic changes in the human testis after vasectomy. A controlled study. N Engl J Med 1985; 313: 1252-1256. 17. Mehrotra R, Nath P, Singh K M et al. Changes in seminiferous tubules after vasectomy. Indian J Pathol Microbial 1985; 28: 371-378. 18. Samuel T, Kolk A H J, Rumke P, van Lis J M J. Autoimmunity to sperm antigens in vasectomized men. Clin Exp Immunol 1975; 21: 65-74. 19. Ansbacher R, Hodge P, Williams A, Mumford D M. Vas ligation, humoral sperm antibodies. Int J Fert 1976; 21: 258-260. 20. Rosemberg E, Marks S C, Howard P J, James L P. Serum levels of follicle stimulating and luteinizing hormones before and after vasectomy in men. J Urol 1974; 111: 626-629. 21. Kobrinsky N L, Winter J S D, Reyes F I, Fairman C. Endocrine effects of vasectomy in men. Fertil Steril 1976; 21: 152-156. 22. Naik V K, Thakur A N, Sheth A R et al. The effect of vasectomy on pituitary-gonadal function in men. J Reprod Fertil 1976; 48: 441-442. 23. Smith K D, Tcholakian R K, Chowdhury M, Hai B P. Endocrine studies in vasectomized men. In: Lepow I H, Crozier R, eds. Vasectomy: immunologic and
138 Fibrinolysis and Coagulation Markers in Seminal Plasma Before and After Vasectomy
24. 25.
26.
27. 28.
29. 30.
31.
32.
33.
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Received: 23 March 1992 Accepted after revision: 17 October 1992 Offprint orders to: J. W. J. van Wersch, Department of Haematology, De Wever Hospital, P.O. Box 4446,640l CX Heerlen, The Netherlands.
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