Testicular Heat Stress and Sperm Quality

  • Damayanthi Durairajanayagam
  • Rakesh K. Sharma
  • Stefan S. du Plessis
  • Ashok Agarwal


Testicular temperature is reflected by the temperature of the overlying scrotum. The scrotum is well placed anatomically and is capable of physiologically maintaining a hypothermic testis. However, when normal thermoregulation of the testis is impaired, heat stress can occur, negatively effecting semen quality and sperm concentration, motility, and morphology. A number of factors can disturb thermoregulation and increase testicular temperature including pathological conditions such as varicocele and cryptorchidism, posture, clothing, common lifestyle choices such as use of saunas and warm baths, certain exercises such as cycling, laptop usage and occupations that involve or generate heat, and raised ambient temperature. Often, these factors do not occur alone but in combination with one another, which compounds the negative effect of high testicular heat levels on semen parameters. This chapter discusses physiological thermoregulation in the testis, the impact of its failure on semen quality and enumerates factors that could simultaneously and cumulatively contribute to testicular heat stress. Awareness of the potential risks involved and methods to alleviate prolonged scrotal warming are important in the preservation of male fertility. Simple changes to daily habits could help lessen the impact of increased testicular temperatures on male fertility.


Heat Stress Sperm Motility Sperm Count Core Body Temperature Heat Exposure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Thonneau P, Bujan L, Multigner L, Mieusset R. Occupational heat exposure and male fertility: a review. Hum Reprod. 1998;13(8):2122–5.PubMedGoogle Scholar
  2. 2.
    Morgentaler A, Stahl BC, Yin Y. Testis and temperature: an historical, clinical, and research perspective. J Androl. 1999;20(2):189–95.PubMedGoogle Scholar
  3. 3.
    Mieusset R, Bujan L. Testicular heating and its possible contributions to male infertility: a review. Int J Androl. 1995;18(4):169–84.PubMedGoogle Scholar
  4. 4.
    Waites GM. Thermoregulation of the scrotum and testis: studies in animals and significance for man. Adv Exp Med Biol. 1991;286:9–17.PubMedGoogle Scholar
  5. 5.
    Candas V, Becmeur F, Bothorel B, Hoeft A. Qualitative assessment of thermal and evaporative adjustments of human scrotal skin in response to heat stress. Int J Androl. 1993;16(2):137–42.PubMedGoogle Scholar
  6. 6.
    Schoor RA, Elhanbly SM, Niederberger C. The pathophysiology of varicocele-associated male infertility. Curr Urol Rep. 2001;2(6):432–6.PubMedGoogle Scholar
  7. 7.
    Glad Sorensen H, Lambrechtsen J, Einer-Jensen N. Efficiency of the countercurrent transfer of heat and 133Xenon between the pampiniform plexus and testicular artery of the bull under in-vitro conditions. Int J Androl. 1991;14(3):232–40.PubMedGoogle Scholar
  8. 8.
    Shiraishi K. Heat and oxidative stress in the germ line. In: Agarwal A, Aitken RJ, Alvarez JG, editors. Studies on men’s health and fertility (oxidative stress in applied basic research and clinical practice). New York, NY: Springer Science + Business Media; 2012. p. 149–78.Google Scholar
  9. 9.
    Lue YH, Hikim AP, Swerdloff RS, Im P, Taing KS, Bui T, et al. Single exposure to heat induces stage-specific germ cell apoptosis in rats: role of intratesticular testosterone on stage specificity. Endocrinology. 1999;140(4):1709–17.PubMedGoogle Scholar
  10. 10.
    Chowdhury AK, Steinberger E. Early changes in the germinal epithelium of rat testes following exposure to heat. J Reprod Fertil. 1970;22(2):205–12.PubMedGoogle Scholar
  11. 11.
    Carlsen E, Andersson AM, Petersen JH, Skakkebaek NE. History of febrile illness and variation in semen quality. Hum Reprod. 2003;18(10):2089–92.PubMedGoogle Scholar
  12. 12.
    Munkelwitz R, Gilbert BR. Are boxer shorts really better? A critical analysis of the role of underwear type in male subfertility. J Urol. 1998;160(4):1329–33.PubMedGoogle Scholar
  13. 13.
    Cai H, Ren Y, Li XX, Yang JL, Zhang CP, Chen M, et al. Scrotal heat stress causes a transient alteration in tight junctions and induction of TGF-beta expression. Int J Androl. 2011;34(4):352–62.PubMedGoogle Scholar
  14. 14.
    Kanter M, Aktas C. Effects of scrotal hyperthermia on Leydig cells in long-term: a histological, immunohistochemical and ultrastructural study in rats. J Mol Histol. 2009;40(2):123–30.PubMedGoogle Scholar
  15. 15.
    Jensen TK, Andersson AM, Hjollund NH, Scheike T, Kolstad H, Giwercman A, et al. Inhibin B as a serum marker of spermatogenesis: correlation to differences in sperm concentration and follicle-stimulating hormone levels. A study of 349 Danish men. J Clin Endocrinol Metab. 1997;82(12):4059–63.PubMedGoogle Scholar
  16. 16.
    Hjollund NH, Storgaard L, Ernst E, Bonde JP, Olsen J. Impact of diurnal scrotal temperature on semen quality. Reprod Toxicol. 2002;16(3):215–21.PubMedGoogle Scholar
  17. 17.
    Setchell BP, Ploen L, Ritzen EM. Effect of local heating of rat testes after suppression of spermatogenesis by pretreatment with a GnRH agonist and an anti-androgen. Reproduction. 2002;124(1):133–40.PubMedGoogle Scholar
  18. 18.
    Kanter M, Aktas C, Erboga M. Heat stress decreases testicular germ cell proliferation and increases apoptosis in short term: an immunohistochemical and ultrastructural study. Toxicol Ind Health. 2011;29(2):99–113.PubMedGoogle Scholar
  19. 19.
    Lue YH, Lasley BL, Laughlin LS, Swerdloff RS, Hikim AP, Leung A, et al. Mild testicular hyperthermia induces profound transitional spermatogenic suppression through increased germ cell apoptosis in adult cynomolgus monkeys (Macaca fascicularis). J Androl. 2002;23(6):799–805.PubMedGoogle Scholar
  20. 20.
    Paul C, Murray AA, Spears N, Saunders PT. A single, mild, transient scrotal heat stress causes DNA damage, subfertility and impairs formation of blastocysts in mice. Reproduction. 2008;136(1):73–84.PubMedGoogle Scholar
  21. 21.
    Collins P, Lacy D. Studies on the structure and function of the mammalian testis. II Cytological and histochemical observations on the testis of the rat after a single exposure to heat applied for different lengths of time. Proc R Soc Lond B Biol Sci. 1969;172(26):17–38.PubMedGoogle Scholar
  22. 22.
    Paul C, Melton DW, Saunders PT. Do heat stress and deficits in DNA repair pathways have a negative impact on male fertility? Mol Hum Reprod. 2008; 14(1):1–8.PubMedGoogle Scholar
  23. 23.
    Ahotupa M, Huhtaniemi I. Impaired detoxification of reactive oxygen and consequent oxidative stress in experimentally cryptorchid rat testis. Biol Reprod. 1992;46(6):1114–8.PubMedGoogle Scholar
  24. 24.
    Ikeda M, Kodama H, Fukuda J, Shimizu Y, Murata M, Kumagai J, et al. Role of radical oxygen species in rat testicular germ cell apoptosis induced by heat stress. Biol Reprod. 1999;61(2):393–9.PubMedGoogle Scholar
  25. 25.
    Rockett JC, Mapp FL, Garges JB, Luft JC, Mori C, Dix DJ. Effects of hyperthermia on spermatogenesis, apoptosis, gene expression, and fertility in adult male mice. Biol Reprod. 2001;65(1):229–39.PubMedGoogle Scholar
  26. 26.
    World Health Organization (WHO) Department of Reproductive Health and Research. WHO laboratory manual for the examination and processing of human semen. 5th ed. Geneva, Switzerland: WHO; 2010.Google Scholar
  27. 27.
    Kompanje EJO. ‘Real men wear kilts’. The anecdotal evidence that wearing a Scottish kilt has influence on reproductive potential: how much is true? Scott Med J. 2013;58(1):e1–5.PubMedGoogle Scholar
  28. 28.
    Mieusset R, Quintana Casares P, Sanchez Partida LG, Sowerbutts SF, Zupp JL, Setchell BP. Effects of heating the testes and epididymides of rams by scrotal insulation on fertility and embryonic mortality in ewes inseminated with frozen semen. J Reprod Fertil. 1992;94(2):337–43.PubMedGoogle Scholar
  29. 29.
    Mieusset R, Bujan L, Mondinat C, Mansat A, Pontonnier F, Grandjean H. Association of scrotal hyperthermia with impaired spermatogenesis in infertile men. Fertil Steril. 1987;48(6):1006–11.PubMedGoogle Scholar
  30. 30.
    Hjollund NH, Bonde JP, Jensen TK, Olsen J. Diurnal scrotal skin temperature and semen quality. The Danish First Pregnancy Planner Study Team. Int J Androl. 2000;23(5):309–18.PubMedGoogle Scholar
  31. 31.
    Wang C, McDonald V, Leung A, Superlano L, Berman N, Hull L, et al. Effect of increased scrotal temperature on sperm production in normal men. Fertil Steril. 1997;68(2):334–9.PubMedGoogle Scholar
  32. 32.
    Brindley GS. Deep scrotal temperature and the effect on it of clothing, air temperature, activity, posture and paraplegia. Br J Urol. 1982;54(1):49–55.PubMedGoogle Scholar
  33. 33.
    Dada R, Gupta NP, Kucheria K. Deterioration of sperm morphology in men exposed to high temperature. J Anat Soc India. 2001;50(2):107.Google Scholar
  34. 34.
    Dada R, Gupta NP, Kucheria K. Spermatogenic arrest in men with testicular hyperthermia. Teratog Carcinog Mutagen. 2003;Suppl 1:235–43.Google Scholar
  35. 35.
    Saikhun J, Kitiyanant Y, Vanadurongwan V, Pavasuthipaisit K. Effects of sauna on sperm movement characteristics of normal men measured by computer-assisted sperm analysis. Int J Androl. 1998;21(6):358–63.PubMedGoogle Scholar
  36. 36.
    Zorgniotti AW, Macleod J. Studies in temperature, human semen quality, and varicocele. Fertil Steril. 1973;24(11):854–63.PubMedGoogle Scholar
  37. 37.
    Evenson DP, Jost LK, Corzett M, Balhorn R. Characteristics of human sperm chromatin structure following an episode of influenza and high fever: a case study. J Androl. 2000;21(5):739–46.PubMedGoogle Scholar
  38. 38.
    Gorelick JI, Goldstein M. Loss of fertility in men with varicocele. Fertil Steril. 1993;59(3):613–6.PubMedGoogle Scholar
  39. 39.
    Brugh III VM, Matschke HM, Lipshultz LI. Male factor infertility. Endocrinol Metab Clin North Am. 2003;32(3):689–707.PubMedGoogle Scholar
  40. 40.
    Setchell BP. The Parkes Lecture. Heat and the testis. J Reprod Fertil. 1998;114(2):179–94.PubMedGoogle Scholar
  41. 41.
    Agger P. Scrotal and testicular temperature: its relation to sperm count before and after operation for varicocele. Fertil Steril. 1971;22(5):286–97.PubMedGoogle Scholar
  42. 42.
    Goldstein M, Eid JF. Elevation of intratesticular and scrotal skin surface temperature in men with varicocele. J Urol. 1989;142(3):743–5.PubMedGoogle Scholar
  43. 43.
    Shiraishi K, Takihara H, Matsuyama H. Elevated scrotal temperature, but not varicocele grade, reflects testicular oxidative stress-mediated apoptosis. World J Urol. 2010;28(3):359–64.PubMedGoogle Scholar
  44. 44.
    Ku JH, Shim HB, Kim SW, Paick JS. The role of apoptosis in the pathogenesis of varicocele. BJU Int. 2005;96(7):1092–6.PubMedGoogle Scholar
  45. 45.
    Chan CC, Sun GH, Shui HA, Wu GJ. Differential spermatozoal protein expression profiles in men with varicocele compared to control subjects: upregulation of heat shock proteins 70 and 90 in varicocele. Urology. 2013;81(6):1379.e1–8.Google Scholar
  46. 46.
    Barthold JS, Gonzalez R. The epidemiology of congenital cryptorchidism, testicular ascent and orchiopexy. J Urol. 2003;170(6 Pt 1):2396–401.PubMedGoogle Scholar
  47. 47.
    Agoulnik AI, Huang Z, Ferguson L. Spermatogenesis in cryptorchidism. Methods Mol Biol. 2012;825:127–47.PubMedGoogle Scholar
  48. 48.
    Peltola V, Huhtaniemi I, Ahotupa M. Abdominal position of the rat testis is associated with high level of lipid peroxidation. Biol Reprod. 1995;53(5):1146–50.PubMedGoogle Scholar
  49. 49.
    Li YC, Hu XQ, Xiao LJ, Hu ZY, Guo J, Zhang KY, et al. An oligonucleotide microarray study on gene expression profile in mouse testis of experimental cryptorchidism. Front Biosci. 2006;11:2465–82.PubMedGoogle Scholar
  50. 50.
    Lee PA, Coughlin MT. Leydig cell function after cryptorchidism: evidence of the beneficial result of early surgery. J Urol. 2002;167(4):1824–7.PubMedGoogle Scholar
  51. 51.
    Liu Y, Li X. Molecular basis of cryptorchidism-induced infertility. Sci China Life Sci. 2010;53(11): 1274–83.PubMedGoogle Scholar
  52. 52.
    Bertolla RP, Cedenho AP, Hassun Filho PA, Lima SB, Ortiz V, Srougi M. Sperm nuclear DNA fragmentation in adolescents with varicocele. Fertil Steril. 2006;85(3):625–8.PubMedGoogle Scholar
  53. 53.
    Banks S, King SA, Irvine DS, Saunders PT. Impact of a mild scrotal heat stress on DNA integrity in murine spermatozoa. Reproduction. 2005;129(4):505–14.PubMedGoogle Scholar
  54. 54.
    Zorgniotti AW. Non-invasive scrotal thermometry. Adv Exp Med Biol. 1991;286:111–4.PubMedGoogle Scholar
  55. 55.
    Zorgniotti AW. Elevated intrascrotal temperature. II: Indirect testis and intrascrotal temperature measurement for clinical and research use. Bull N Y Acad Med. 1982;58(6):541–4.PubMedCentralPubMedGoogle Scholar
  56. 56.
    Hjollund NH, Storgaard L, Ernst E, Bonde JP, Olsen J. The relation between daily activities and scrotal temperature. Reprod Toxicol. 2002;16(3):209–14.PubMedGoogle Scholar
  57. 57.
    Bujan L, Daudin M, Charlet JP, Thonneau P, Mieusset R. Increase in scrotal temperature in car drivers. Hum Reprod. 2000;15(6):1355–7.PubMedGoogle Scholar
  58. 58.
    Jockenhovel F, Grawe A, Nieschlag E. A portable digital data recorder for long-term monitoring of scrotal temperatures. Fertil Steril. 1990;54(4):694–700.PubMedGoogle Scholar
  59. 59.
    Rock J, Robinson D. Effect of induced intrascrotal hyperthermia on testicular function in man. Am J Obstet Gynecol. 1965;93(6):793–801.PubMedGoogle Scholar
  60. 60.
    Lerchl A, Keck C, Spiteri-Grech J, Nieschlag E. Diurnal variations in scrotal temperature of normal men and patients with varicocele before and after treatment. Int J Androl. 1993;16(3):195–200.PubMedGoogle Scholar
  61. 61.
    Jung A, Hofstotter JP, Schuppe HC, Schill WB. Relationship between sleeping posture and fluctuations in nocturnal scrotal temperature. Reprod Toxicol. 2003;17(4):433–8.PubMedGoogle Scholar
  62. 62.
    Koskelo R, Zaproudina N, Vuorikari K. High scrotal temperatures and chairs in the pathophysiology of poor semen quality. Pathophysiology. 2005;11(4):221–4.PubMedGoogle Scholar
  63. 63.
    Mieusset R, Bengoudifa B, Bujan L. Effect of posture and clothing on scrotal temperature in fertile men. J Androl. 2007;28(1):170–5.PubMedGoogle Scholar
  64. 64.
    Song GS, Seo JT. Changes in the scrotal temperature of subjects in a sedentary posture over a heated floor. Int J Androl. 2006;29(4):446–57.PubMedGoogle Scholar
  65. 65.
    Zorgniotti A, Reiss H, Toth A, Sealfon A. Effect of clothing on scrotal temperature in normal men and patients with poor semen. Urology. 1982;19(2):176–8.PubMedGoogle Scholar
  66. 66.
    Elebute EA. The relationship of skin temperatures of clothed adults to ambient temperature in a warm environment. Afr J Med Med Sci. 1976;5(2):175–8.PubMedGoogle Scholar
  67. 67.
    Laven JS, Haverkorn MJ, Bots RS. Influence of occupation and living habits on semen quality in men (scrotal insulation and semen quality). Eur J Obstet Gynecol Reprod Biol. 1988;29(2):137–41.PubMedGoogle Scholar
  68. 68.
    Lynch R, Lewis-Jones DI, Machin DG, Desmond AD. Improved seminal characteristics in infertile men after a conservative treatment regimen based on the avoidance of testicular hyperthermia. Fertil Steril. 1986;46(3):476–9.PubMedGoogle Scholar
  69. 69.
    Tiemessen CH, Evers JL, Bots RS. Tight-fitting underwear and sperm quality. Lancet. 1996; 347(9018):1844–5.PubMedGoogle Scholar
  70. 70.
    Partsch CJ, Aukamp M, Sippell WG. Scrotal temperature is increased in disposable plastic lined nappies. Arch Dis Child. 2000;83(4):364–8.PubMedCentralPubMedGoogle Scholar
  71. 71.
    Grove GL, Grove MJ, Bates NT, Wagman LM, Leyden JJ. Scrotal temperatures do not differ among young boys wearing disposable or reusable diapers. Skin Res Technol. 2002;8(4):260–70.PubMedGoogle Scholar
  72. 72.
    Jung A, Schuppe HC. Influence of genital heat stress on semen quality in humans. Andrologia. 2007;39(6): 203–15.PubMedGoogle Scholar
  73. 73.
    Hammoud AO, Gibson M, Peterson CM, Meikle AW, Carrell DT. Impact of male obesity on infertility: a critical review of the current literature. Fertil Steril. 2008;90(4):897–904.PubMedGoogle Scholar
  74. 74.
    Kort HI, Massey JB, Elsner CW, Mitchell-Leef D, Shapiro DB, Witt MA, et al. Impact of body mass index values on sperm quantity and quality. J Androl. 2006;27(3):450–2.PubMedGoogle Scholar
  75. 75.
    Ivell R. Lifestyle impact and the biology of the human scrotum. Reprod Biol Endocrinol. 2007;5:15.PubMedCentralPubMedGoogle Scholar
  76. 76.
    Shafik A, Olfat S. Lipectomy in the treatment of scrotal lipomatosis. Br J Urol. 1981;53(1):55–61.PubMedGoogle Scholar
  77. 77.
    Shafik A, Olfat S. Scrotal lipomatosis. Br J Urol. 1981;53(1):50–4.PubMedGoogle Scholar
  78. 78.
    Keast ML, Adamo KB. The Finnish sauna bath and its use in patients with cardiovascular disease. J Cardiopulm Rehabil. 2000;20(4):225–30.PubMedGoogle Scholar
  79. 79.
    Brown-Woodman PD, Post EJ, Gass GC, White IG. The effect of a single sauna exposure on spermatozoa. Arch Androl. 1984;12(1):9–15.PubMedGoogle Scholar
  80. 80.
    Garolla A, Torino M, Sartini B, Cosci I, Patassini C, Carraro U, et al. Seminal and molecular evidence that sauna exposure affects human spermatogenesis. Hum Reprod. 2013;28(4):877–85.PubMedGoogle Scholar
  81. 81.
    Shefi S, Tarapore PE, Walsh TJ, Croughan M, Turek PJ. Wet heat exposure: a potentially reversible cause of low semen quality in infertile men. Int Braz J Urol. 2007;33(1):50–6, discussion 56–7.Google Scholar
  82. 82.
    Jung A, Strauss P, Lindner HJ, Schuppe HC. Influence of moderate cycling on scrotal temperature. Int J Androl. 2008;31(4):403–7.PubMedGoogle Scholar
  83. 83.
    Lucia A, Chicharro JL, Perez M, Serratosa L, Bandres F, Legido JC. Reproductive function in male endurance athletes: sperm analysis and hormonal profile. J Appl Physiol. 1996;81(6):2627–36.PubMedGoogle Scholar
  84. 84.
    Sheynkin Y, Jung M, Yoo P, Schulsinger D, Komaroff E. Increase in scrotal temperature in laptop computer users. Hum Reprod. 2005;20(2):452–5.PubMedGoogle Scholar
  85. 85.
    Bonde JP. Semen quality in welders exposed to radiant heat. Br J Ind Med. 1992;49(1):5–10.PubMedCentralPubMedGoogle Scholar
  86. 86.
    Kumar S, Zaidi SS, Gautam AK, Dave LM, Saiyed HN. Semen quality and reproductive hormones among welders—a preliminary study. Environ Health Prev Med. 2003;8(2):64–7.PubMedCentralPubMedGoogle Scholar
  87. 87.
    Thonneau P, Ducot B, Bujan L, Mieusset R, Spira A. Effect of male occupational heat exposure on time to pregnancy. Int J Androl. 1997;20(5):274–8.PubMedGoogle Scholar
  88. 88.
    Figa-Talamanca I, Dell’Orco V, Pupi A, Dondero F, Gandini L, Lenzi A, et al. Fertility and semen quality of workers exposed to high temperatures in the ceramics industry. Reprod Toxicol. 1992;6(6):517–23.PubMedGoogle Scholar
  89. 89.
    Sas M, Szollosi J. Impaired spermiogenesis as a common finding among professional drivers. Arch Androl. 1979;3(1):57–60.PubMedGoogle Scholar
  90. 90.
    Henderson J, Rennie GC, Baker HW. Association between occupational group and sperm concentration in infertile men. Clin Reprod Fertil. 1986;4(4):275–81.PubMedGoogle Scholar
  91. 91.
    Chia SE, Ong CN, Lee ST, Tsakok FH. Study of the effects of occupation and industry on sperm quality. Ann Acad Med Singapore. 1994;23(5):645–9.PubMedGoogle Scholar
  92. 92.
    Figa-Talamanca I, Cini C, Varricchio GC, Dondero F, Gandini L, Lenzi A, et al. Effects of prolonged autovehicle driving on male reproduction function: a study among taxi drivers. Am J Ind Med. 1996;30(6): 750–8.PubMedGoogle Scholar
  93. 93.
    Thonneau P, Ducot B, Bujan L, Mieusset R, Spira A. Heat exposure as a hazard to male fertility. Lancet. 1996;347(8995):204–5.PubMedGoogle Scholar
  94. 94.
    Jung A, Strauss P, Lindner HJ, Schuppe HC. Influence of heating car seats on scrotal temperature. Fertil Steril. 2008;90(2):335–9.PubMedGoogle Scholar
  95. 95.
    Velez de la Calle JF, Rachou E, le Martelot MT, Ducot B, Multigner L, Thonneau PF. Male infertility risk factors in a French military population. Hum Reprod. 2001;16(3):481–6.Google Scholar
  96. 96.
    Jorgensen N, Andersen AG, Eustache F, Irvine DS, Suominen J, Petersen JH, et al. Regional differences in semen quality in Europe. Hum Reprod. 2001; 16(5):1012–9.PubMedGoogle Scholar
  97. 97.
    Tjoa WS, Smolensky MH, Hsi BP, Steinberger E, Smith KD. Circannual rhythm in human sperm count revealed by serially independent sampling. Fertil Steril. 1982;38(4):454–9.PubMedGoogle Scholar
  98. 98.
    Gyllenborg J, Skakkebaek NE, Nielsen NC, Keiding N, Giwercman A. Secular and seasonal changes in semen quality among young Danish men: a statistical analysis of semen samples from 1927 donor candidates during 1977–1995. Int J Androl. 1999;22(1):28–36.PubMedGoogle Scholar
  99. 99.
    Mallidis C, Howard EJ, Baker HW. Variation of semen quality in normal men. Int J Androl. 1991; 14(2):99–107.PubMedGoogle Scholar
  100. 100.
    Mathew V, Bantwal G. Male contraception. Indian J Endocrinol Metab. 2012;16(6):910–7.PubMedCentralPubMedGoogle Scholar
  101. 101.
    Mieusset R, Bujan L. The potential of mild testicular heating as a safe, effective and reversible contraceptive method for men. Int J Androl. 1994;17(4): 186–91.PubMedGoogle Scholar
  102. 102.
    Wang C, Cui YG, Wang XH, Jia Y, Sinha Hikim A, Lue YH, et al. Transient scrotal hyperthermia and levonorgestrel enhance testosterone-induced spermatogenesis suppression in men through increased germ cell apoptosis. J Clin Endocrinol Metab. 2007;92(8):3292–304.PubMedGoogle Scholar
  103. 103.
    Osman MW, Nikolopoulos L, Haoula Z, Kannamannadiar J, Atiomo W. A study of the effect of the FertilMate Scrotum Cooling Patch on male fertility. SCOP trial (scrotal cooling patch)—study protocol for a randomised controlled trial. Trials. 2012;13:47.PubMedCentralPubMedGoogle Scholar
  104. 104.
    Robinson D, Rock J, Menkin MF. Control of human spermatogenesis by induced changes of intrascrotal temperature. JAMA. 1968;204(4):290–7.PubMedGoogle Scholar
  105. 105.
    Mulcahy JJ. Scrotal hypothermia and the infertile man. J Urol. 1984;132(3):469–70.PubMedGoogle Scholar
  106. 106.
    Zorgniotti AW, Cohen MS, Sealfon AI. Chronic scrotal hypothermia: results in 90 infertile couples. J Urol. 1986;135(5):944–7.PubMedGoogle Scholar
  107. 107.
    Jung A, Eberl M, Schill WB. Improvement of semen quality by nocturnal scrotal cooling and moderate behavioural change to reduce genital heat stress in men with oligoasthenoteratozoospermia. Reproduction. 2001;121(4):595–603.PubMedGoogle Scholar
  108. 108.
    Zorgniotti AW, Sealfon AI, Toth A. Chronic scrotal hypothermia as a treatment for poor semen quality. Lancet. 1980;1(8174):904–6.PubMedGoogle Scholar
  109. 109.
    Zorgniotti AW, Sealfon AI. Measurement of intrascrotal temperature in normal and subfertile men. J Reprod Fertil. 1988;82(2):563–6.PubMedGoogle Scholar
  110. 110.
    Zorgniotti AW, Toth A, Macleod J. Infrared thermometry for testicular temperature determinations. Fertil Steril. 1979;32(3):347–8.PubMedGoogle Scholar
  111. 111.
    Jung A, Leonhardt F, Schill WB, Schuppe HC. Influence of the type of undertrousers and physical activity on scrotal temperature. Hum Reprod. 2005;20(4):1022–7.PubMedGoogle Scholar
  112. 112.
    Mieusset R, Fouda PJ, Vaysse P, Guitard J, Moscovici J, Juskiewenski S. Increase in testicular temperature in case of cryptorchidism in boys. Fertil Steril. 1993;59(6):1319–21.PubMedGoogle Scholar
  113. 113.
    Shafik A. Testicular suspension as a method of male contraception: technique and results. Adv Contracept Deliv Syst. 1991;7(3–4):269–79.PubMedGoogle Scholar
  114. 114.
    Mieusset R, Grandjean H, Mansat A, Pontonnier F. Inhibiting effect of artificial cryptorchidism on spermatogenesis. Fertil Steril. 1985;43(4):589–94.PubMedGoogle Scholar
  115. 115.
    Jung A, Schill WB, Schuppe HC. Improvement of semen quality by nocturnal scrotal cooling in oligozoospermic men with a history of testicular maldescent. Int J Androl. 2005;28(2):93–8.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Damayanthi Durairajanayagam
    • 1
  • Rakesh K. Sharma
    • 1
  • Stefan S. du Plessis
    • 2
  • Ashok Agarwal
    • 1
  1. 1.Center for Reproductive MedicineCleveland ClinicClevelandUSA
  2. 2.Division of Medical Physiology, Department of Biomedical Sciences, Faculty of Medicine and Health SciencesStellenbosch UniversityTygerbergSouth Africa

Personalised recommendations