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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 12  |  Issue : 2  |  Page : 41-44

The relationships between serum prolactin level and semen analysis parameters among patients attended the reproductive health center, Khartoum 2016–2017


Department of Physiology, International University of Africa, Khartoum, Sudan

Date of Web Publication24-May-2018

Correspondence Address:
Humeda Suekit Ahmed
Department of Physiology, International University of Africa, Khartoum
Sudan
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DOI: 10.4103/summ.summ_46_17

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  Abstract 


Introduction: This study aimed to determinate the effects of serum prolactin (PRL) level on semen analysis parameters (semen volume, sperm count, sperm motility, and sperm morphology). Subjects and Methods: This study was observational descriptive retrospective cross-sectional study. The study included 212 male patients selected by systematic random sampling from all patients who attended the reproductive health-care center in Khartoum. Data were collected from the all participants files. Serum PRL level and semen analysis parameters were obtained from laboratory records. Participants were classified into hyperprolactinemic and normal PRL level groups according to their serum PRL level. Data were analyzed using the Statistical Package for Social Science version 23. Descriptive data were presented as mean/median ± standard deviation/standard error of mean (SEM) or percentages. Independent t-test was used to determine the differences in semen analysis parameters between the two study groups. P < 0.05 was considered statistically significant. Results: Our study showed high level of PRL hormone among study participants (median = 543.0, SEM = 43.1 ml IU/L). There were significant differences in sperm motility and morphology between normal and hyperprolactinemic patients (P = 0.05 and 0.01, respectively). However, there were no significant differences in semen volume or sperm count between the two study groups. There were negative significant correlations between the PRL level and percentage of motile sperms (P = 0.001) and the percentage of normal morphology sperms (P = 0.001). However, there were no significant correlations between PRL level and sperm count or semen volume. Conclusion: Hyperprolactinemia in males causes significant changes in semen contents which may explain infertility in those patients.

Keywords: Hyperprolactinemia, infertility, semen volume, sperm count, sperm morphology, sperm motility


How to cite this article:
Ahmed ND, Ahmed HS. The relationships between serum prolactin level and semen analysis parameters among patients attended the reproductive health center, Khartoum 2016–2017. Sudan Med Monit 2017;12:41-4

How to cite this URL:
Ahmed ND, Ahmed HS. The relationships between serum prolactin level and semen analysis parameters among patients attended the reproductive health center, Khartoum 2016–2017. Sudan Med Monit [serial online] 2017 [cited 2018 Oct 18];12:41-4. Available from: http://www.sudanmedicalmonitor.org/text.asp?2017/12/2/41/233105




  Introduction Top


Prolactin (PRL) is a hormone that is best known for its role in enabling mammals, usually females, to produce milk. Although PRL seems to play an important role in the energy metabolism of human sperm,[1] high PRL concentrations have inhibitory effects in both humans and animals. In particular, hyperprolactinemia decreases the pulsatile secretion of luteinizing hormone (LH) and, to a lesser extent, of follicle-stimulating hormone (FSH). (54)[2]

PRL excess causes male infertility by altering semen analysis parameters.[3] Many studies investigated the effects of serum PRL level on semen analysis parameters. Some of them reported strong associations between the PRL level and semen analysis parameters,[4],[5],[6],[7],[8] while others showed no significant associations between the PRL level and semen analysis parameters.[3],[9],[10],[11] Several studies showed significant association between PRL level and semen volume.[12],[13] It has been found that any increase in serum PRL level impairs fertility by decreasing sperm concentration and motility without affecting sperm morphology.[5] Hyperprolactinemia impairs motility and sperm quality and produces morphologic alterations similar to those observed in prepubertal testes.[4] Other studies showed insignificant correlations between serum PRL on one hand and sperm count,[14] sperm motility, and semen volume [3],[15],[16],[17] on the other hand.

Although there were several studies that investigated the effects of serum PRL level on semen analysis parameters, few attempts were made in Sudan to determine these effects. Therefore, this study aimed to determine the effects of serum PRL level on semen analysis parameters (semen volume, sperm count, sperm motility, and sperm morphology) among males attending reproductive health-care center in Khartoum, Sudan.


  Subjects and Methods Top


This was observational descriptive retrospective cross-sectional study conducted at reproductive health-care center which is located in Khartoum state in the Mac Nimir Street near the Khartoum Teaching Hospital. The study included all male patients who attended the reproductive health-care center during the period from March 2016 to March 2017 (500 males). The sample size was calculated using the equation: n = N/1 + N (d) 2 and 212 males were selected by systematic random sampling method. Data were collected from patients' files, and semen analysis parameters results were obtained from laboratory records. Then, participants were classified into normal and abnormal PRL level according to kits manufacturer (≤375 mlIU/L as cutoff point). Data were fed in IBM computer and analyzed using Statistical package for social sciences version 23 (IBM corp., Armonk, N. Y.). Descriptive data were presented as mean/median ± standard deviation/standard error of mean (SEM). The relationships between serum PRL level and semen analysis parameters (semen volume, sperm count, sperm motility, and sperm morphology) were analyzed using Pearson correlation test. Furthermore, independent test was used to determine the differences in semen analysis parameters between normal and hyperprolactinemic participants. P < 0.05 was considered statistically significant. The study was conducted after the approval of the Ethical committee at International University of Africa and the approval of reproductive health-care center. Furthermore, verbal consent was taken from each participant.


  Results Top


The average age of the participants was 37.0 ± 1.70 years. The average serum PRL level was 531.0 ± 43.1 ml IU/L. The average values for semen volume were 2.39 ± 1.21 ml, semen count were 6.65 ± 3.62 × 106/ml, percentage of motile sperms were 30% ±1.72%, and percentage of normal morphology sperms were 33% ± 1.40% [Table 1].
Table 1: Age, prolactin level, and semen analysis parameters among study participants (n=212)

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Most of the study participants (90.1%) were hyperprolactinemic (PRL level >375 ml IU/L) and 9.9% had normal serum PRL level [Table 2].
Table 2: Distribution of participants according to prolactin level (n=212)

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There were significant differences in sperm motility and morphology between the two groups (P = 0.03 and 0.01, respectively). However, there were no significant differences in age, semen volume, or semen count between normal and hyperprolactinemic males (P = 0.78, 0.84, and 0.36, respectively) [Table 3].
Table 3: Comparison of age and seminal analysis parameters between normal and hyperprolactinemic participants (n=212)

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Pearson correlation test showed significant negative correlations between PRL level and the percentages of motile sperms and of normal morphology sperms (P = 0.005 and 0.001, respectively). PRL level had no significant correlations with semen volume or sperm count (P = 0.60 and 0.26, respectively) [Table 4].
Table 4: The correlations between serum prolactin level and semen analysis parameters (n=212)

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  Discussion Top


Our study showed high level of PRL among participants, and this is in agreement with other studies which revealed high PRL level among infertile men.[4],[16],[17] Normal PRL level increases the production of steroids and androgen by increasing the LH receptors in Leydig cells, FSH receptors in  Sertoli cells More Details, the total lipid production in germ cells, and conversion of spermatocyte to spermatid.[11] However, in hyperprolactinemia, serum testosterone levels are generally low without an accompanying increase in LH levels.[15]

In the present study, there was no statistical significant difference in semen volume between hyperprolactinemic and normal males. Furthermore, there was no statistical significant association between PRL level and semen volume. Several studies showed this insignificant association between PRL level and semen volume.[3],[15],[16],[17] However, other studies showed significant negative association between PRL and semen volume.[12],[13]

In this study, there was no statistical significant difference in sperm count between the two study groups. Furthermore, there was no statistical significant association between PRL level and sperm count. A study conducted by Wein et al., 2011, for assessing the clinical significance of PRL determination, during infertility investigations, on serum samples of 204 males showed no significant correlation between serum PRL level and sperm count.[15] Okada et al., 1996, investigated the relationship between serum PRL and semen analysis parameters and showed no statistical significant correlation between PRL level and sperm count.[14] Gunasekar et al., 1991 found no correlation between sperm count and hyperprolactinemia.[11] However, other studies revealed significant negative association between these two parameters.[4],[6],[18],[19],[20]

Our study showed significant difference in the percentage of motile sperms between high and normal PRL level patients. Furthermore, there was significant negative relationship between PRL level and the percentage of motile sperms. Velázquez-Ramírez et al., 1980 found statistical significant negative association between PRL level and the percentage of motile sperms.[21] Seminal quality and levels and serum PRL were determined in 60 men attending an infertility service center and showed that men with high serum PRL level had low percentage of motile sperms.[6] A study included 120 patients who were divided into four groups of asthenozoospermia, oligozoospermia, severe oligozoospermia, and azoospermia revealed that PRL level had significant effects on sperm concentration and motility.[4] However, few studies showed insignificant relationship between PRL level and sperm motility.[9] Hyperprolactinemia had a negative effect on sperm motility by decreasing ATP production from mitochondria.[22] Furthermore, hyperprolactinemia may be associated with thyroid dysfunction,[23] decrease of parathyroid hormone causes decrease in calcium, Ca2+ channels are the key components in male reproduction such as in the acrosome reaction and sperm motility, and this may explain the hyperprolactinemia effects on sperm motility.[24] Furthermore, this association can be explained by the relationship between sperm autoantibody and hyperprolactinemia.[24]

The present study showed significant difference in the percentages of normal morphology sperms between the two study groups and negative significant correlation between PRL level and the percentage of normal morphology sperms. A study conducted by Al-Daghistani et al., 2006 found that hyperprolactinemia produces morphologic alterations in sperms similar to those observed in prepubertal testis.[20] However, it has been found that any increase in serum PRL level impairs fertility by decreasing in sperm concentration and motility without affecting sperm morphology.[5] The negative strong correlation between PRL level and sperm morphology, observed in this study, could be explained by the effect of PRL on cell division.[13]


  Conclusion Top


High PRL level is associated with low percentage of motile sperms and low percentage of normal morphology sperms. These results could explain high PRL level among infertile men.

Further studies are needed to investigate the possible mechanisms by which high PRL level can affect semen analysis parameters.

Acknowledgment

The authors would like to thank the reproductive health-care center staff for their kind cooperation. Also, many thanks to the study participants for their patience and compliance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Garbers DL, Lust WD, First NL, Lardy HA. Effects of phosphodiesterase inhibitors and cyclic nucleotides on sperm respiration and motility. Biochemistry 1971;10:1825-31.  Back to cited text no. 1
    
2.
Murray FT, Cameron DF, Ketchum C. Return of gonadal function in men with prolactin-secreting pituitary tumors. J Clin Endocrinol Metab 1984;59:79-85.  Back to cited text no. 2
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3.
Turek PJ. Male infertility. In: Tanagho EA, McAninch JW, editors. Smiths General Urologys. 17th ed. USA: The McGraw-Hill Companies; 2008.  Back to cited text no. 3
    
4.
De Rosa M, Zarrilli S, Di Sarno A, Milano N, Gaccione M, Boggia B, et al. Hyperprolactinemia in men: Clinical and biochemical features and response to treatment. Endocrine 2003;20:75-82.  Back to cited text no. 4
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5.
Luboshitzky R, Rosen E, Trestian S, Spitz IM. Hyperprolactinaemia and hypogonadism in men: Response to exogenous gonadotrophins. Clin Endocrinol (Oxf) 1979;11:217-23.  Back to cited text no. 5
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6.
Gonzales GF, Garcia-Hjarles M, Velasquez G. Hyperprolactinaemia and hyperserotoninaemia: Their relationship to seminal quality. Andrologia 1992;24:95-100.  Back to cited text no. 6
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7.
Gill-Sharma MK. Prolactin and male fertility: The long and short feedback regulation. Int J Endocrinol 2009;2009:687259.  Back to cited text no. 7
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8.
Schoenfeld C, Amelar RD, Dubin L, Numeroff M. Prolactin, fructose, and zinc levels found in human seminal plasma. Fertil Steril 1979;32:206-8.  Back to cited text no. 8
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9.
Merino G, Carranza-Lira S, Martinez-Chéquer JC, Barahona E, Morán C, Bermúdez JA. Hyperprolactinemia in men with asthenozoospermia, oligozoospermia, or azoospermia. Syst Biol Reprod Med 1997;38:201-6.  Back to cited text no. 9
    
10.
McNatty KP, Sawers RS, McNeilly AS. A possible role for prolactin in control of steroid secretion by the human Graafian follicle. Nature 1974;250:653-5.  Back to cited text no. 10
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11.
Gunasekar PG, Kumaran B, Govindarajulu P. Role of prolactin on leydig, sertoli and germ cellular neutral lipids in bonnet monkeys, Macaca radiata. Endocrinol Jpn 1991;38:1-8.  Back to cited text no. 11
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Segal S, Yaffe H, Laufer N, Ben-David M. Male hyperprolactinemia: effects on fertility. Fertil Steril 1979;32:556-61.  Back to cited text no. 12
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13.
Baccetti B, Fraioli F, Paolucci D, Selmi G, Spera G, Renieri T. High prolactin level and double spermatozoa. Gamete Res 1979;2:193-9.  Back to cited text no. 13
    
14.
Okada H, Iwamoto T, Fujioka H, Shirakawa T, Tatsumi N, Kanzaki M, et al. Hyperprolactinaemia among infertile patients and its effect on sperm functions. Andrologia 1996;28:197-202.  Back to cited text no. 14
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15.
Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA. Campbell-Walsh Urology: Expert Consult Premium Edition: Enhanced Online Features and Print, 4-Volume Set. Elsevier Health Sciences; 2011.  Back to cited text no. 15
    
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McLachlan RI. Approach to the patient with oligozoospermia. J Clin Endocrinol Metab 2013;98:873-80.  Back to cited text no. 16
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Buvat J. Hyperprolactinemia and sexual function in men: A short review. Int J Impot Res 2003;15:373-7.  Back to cited text no. 17
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Lucas BK, Ormandy CJ, Binart N, Bridges RS, Kelly PA. Null mutation of the prolactin receptor gene produces a defect in maternal behavior. Endocrinology 1998;139:4102-7.  Back to cited text no. 18
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Trautmann JC, Laws ER Jr. Visual status after transsphenoidal surgery at the Mayo Clinic, 1971-1982. Am J Ophthalmol 1983;96:200-8.  Back to cited text no. 19
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20.
Al-Daghistani H, Abdel-Dayem M. Hyperprolactinemia and hypergonadotropins in infertile males with sever oligospermia and azoospermia. Internet J Endocrinol 2002;3:1540-2606.  Back to cited text no. 20
    
21.
Velázquez-Ramírez A, Vilar-Rojas C, Hicks JJ. Similar effects of prolactin and dbcAMP upon human spermatozoa metabolism. Int J Androl 1980;3:23-31.  Back to cited text no. 21
    
22.
Duchen MR. Mitochondria in health and disease: Perspectives on a new mitochondrial biology. Mol Aspects Med 2004;25:365-451.  Back to cited text no. 22
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23.
Ben-David M, Schenker JG. Human ovarian receptors to human prolactin: Implications in infertility. Fertil Steril 1982;38:182-6.  Back to cited text no. 23
    
24.
Goel P, Kahkasha, Narang S, Gupta BK, Goel K. Evaluation of serum prolactin level in patients of subclinical and overt hypothyroidism. J Clin Diagn Res 2015;9:BC15-7.  Back to cited text no. 24
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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