Ampullary, seminal vesicular, and prostatic massage for obtaining spermatozoa from patients with anejaculation

Ejaculatory dysfunction as a cause of infertility

Ejaculatory dysfunction (EjD), the most prevalent male sexual disorder, is clearly different from erectile dysfunction (ED). EjD is divided into 4 categories: premature ejaculation, delayed ejaculation, retrograde ejaculation and anejaculation. EjD-related infertility is one of the most serious problems in young patients. If sexual intercourse is achieved successfully without any ejaculate sexual partners/wives will not be able to conceive. Therefore, establishment of management of EjD as well as ED is increasingly crucial for couples wishing for a baby. The therapeutic approach of EjD-related infertility is based upon two scenarios: (1) if EjD alone is the reason for having no children, adequate treatment for EjD alone is required, or (2) if EjD is not the only reason and is combined with a worsening of semen quality, total management for male infertility (including EjD treatment) is needed. In this article, the background of EjD-related infertility is presented briefly, followed by a review of treatment modalities.

Retrograde vasal sperm aspiration in anejaculatory patients with spinal cord injury

Aim:  This paper describes our experience with retrograde vasal sperm aspiration (ReVSA) in anejaculatory patients with spinal cord injury. Methods:  We performed 11 vasal sperm aspiration procedures on eight patients presenting with neurogenic anejaculation associated with spinal cord injury at our institute between 2004 and 2007. This procedure was conducted under local anesthesia with a spermatic block. A 24G needle was inserted into the vas in a retrograde fashion. Sperm-washing medium was gently injected into the proximal vas several times and collected. Aspirated sperm was cryopreserved for intracytoplasmic sperm injection. Results:  Adequate motile sperm was obtained from all patients. All couples underwent intracytoplasmic sperm injection; clinical pregnancies were achieved in eight cases (two ongoing pregnancies and the births of six healthy babies). Conclusion:  Retrograde vasal sperm aspiration is a reliable method for the consistent recovery of sperm of sufficient quality to afford a high pregnancy rate and in sufficient quantity to permit cryopreservation of excess sperm for future use. (Reprod Med Biol 2008; 7: 115-118).

Semen parameters in men with spinal cord injury: changes and aetiology

AIM

To assess the changes in semen parameters in men with spinal cord injury (SCI) and the possible causes of these changes.

METHODS

The study included 45 subjects with SCI. Semen retrieval was done by masturbation (2), vigorous prostatic massage (n = 13), penile vibratory stimulation (n = 13) or electroejaculation (n = 17).

RESULTS

The semen of men with SCI showed normal volume (2.3 +/- 1.9 mL) and sperm count (85.0 X 10(6) +/- 83.8 X 10(6)/mL) with decreased motility (11.6% +/- 0.1%), vitality (18.5% +/- 5.2%) and normal forms (17.5% +/- 3.4%), and pus cells has been increased (6.0 X 10(6) +/- 8.2 X 10(6)/mL). Total (13.4 +/- 9.9 vs. 7.1 +/- 6.8) and progressive (4.4 +/- 3.9 vs.2.2 +/- 2.1) motility were significantly higher in subjects with lower scrotal temperatures. There was no statistical significant difference between electroejaculation and penile vibratory stimulation groups as regards any of the semen parameters. Subjects'age, infrequent ejaculation, injury duration and hormonal profile showed no significant effect on semen parameters.

CONCLUSION

The defining characteristics of the seminogram in men with SCI are normal volume and count with decreased sperm motility, vitality and normal forms, and the increased number of pus cells. The most acceptable cause of the deterioration of semen is elevated scrotal temperature.

Prostatic massage: a simple method of semen retrieval in men with spinal cord injury

The aim of this study was to evaluate the efficacy of prostatic massage (PM) as a method for obtaining semen in men with spinal cord injury (SCI) and to evaluate the semen parameters in the semen samples obtained by this method. Sixty-nine patients with SCI underwent PM as a trial for semen retrieval. History taking, examination and hormonal assay analysis (follicle-stimulating hormone, luteinizing hormone, prolactin and testosterone) were performed in all patients. Patients were grouped as follows: group 'A' where sperm could be successfully retrieved by PM and group 'B' where no sperm could be retrieved. PM resulted in the production of prostatic secretion in 51 patients (73.9%) and no secretion was obtained in 18 patients. Spermatozoa were successfully retrieved in only 22 patients (31.9%). The semen analysis of the sperm-positive samples showed asthenoteratozoospermia with decreased vitality and increased number of leucocytes. Semen collection by PM was significantly higher in patients with an SCI level above T10. PM is a safe and simple outpatient clinic procedure that can be easily used to retrieve semen in men with SCI.

Comparison between the Sperm Morphology in Semen Samples Obtained from Yearling Beef Bulls by Transrectal Massage of the Ampullae and Cauda Epididymal Dissection

As electroejaculation (EEJ) is prohibited for use on unanaesthetized animals in Sweden, there is a need for an alternative method of semen collection from bulls in the field. The aim of the present study was to evaluate the use of transrectal massage (TM) of the ampullae to collect semen from yearling beef bulls under field conditions in Sweden. Transrectal massage was performed on 52 yearling beef bulls. Volume of semen collected, duration of procedure, percentage progressively motile sperm, and sperm concentration were measured. Smears were prepared for sperm morphology examination. Semen samples were obtained from 47 of 52 bulls. Mean volume was 3.2 ml (SD +/- 3.7), mean duration of collection was 7.4 min (SD +/- 2.8), mean percentage progressively motile sperm was 43.5% (SD +/- 29.2) and mean concentration was 201.9 x 10(6) spermatozoa/ml (SD +/- 278 x 10(6)). Twenty-three of the 52 bulls were slaughtered 3-4 days after semen collection and aliquots of the cauda epididymal contents were collected for sperm morphology examination. The percentages of proximal droplets, abnormal tails and abnormal midpieces were significantly higher (p < 0.05) and the percentage of detached heads was significantly lower (p < 0.05) in the post-mortem samples compared with those in the TM samples. However, importantly there was no significant difference between the two sample types in the percentages of abnormal heads. This study demonstrates that semen can be collected from yearling beef bulls by TM. We think that TM constitutes a useful tool, when semen collection with EEJ or artificial vagina (AV) is not possible under field conditions, when included in the bull breeding soundness evaluation (BBSE) protocol. However, further studies are needed, and presently being carried out, to evaluate if semen samples collected by TM are comparable with semen samples collected by AV.

Analysis of limited fertility in intracytoplasmic sperm injection of sperm obtained by electroejaculation

Background and Aims:  We correlated findings in semen from patients with ejaculatory dysfunction with results of in vitro fertilization using their electroejaculated sperm. Methods and Results:  Electroejaculation was carried out in six patients with the above-mentioned criteria for a total of eight times. Sperm was obtained in six attempts. Intracytoplasmic injection of these sperm was performed in 156 eggs. Sixty-seven eggs were fertilized; most of these were injected with motile sperm. Two women became pregnant, both after injection with motile sperm. As previously reported, electroejaculated sperm showed low motility and a low fertilization rate, but even motile sperm had a low fertilization rate. Conclusion:  The results of the present study suggest the importance in fertilization of undetermined factors in addition to sperm motility. (Reprod Med Biol 2004; 3: 9-12).

Percutaneous vasal sperm aspiration and intrauterine insemination for infertile males with anejaculation

OBJECTIVE

To explore the effectiveness of percutaneous vasal sperm aspiration (PVSA) in combination with intrauterine insemination (IUI) to treat infertile men with anejaculation.

DESIGN

Clinical study.

SETTING

Department of reproductive endocrinology and andrology of a family planning research clinic.

PATIENT(S)

Twenty-six anejaculatory infertile men.

INTERVENTION(S)

Spermatozoa obtained from the vas deferens by percutaneous aspiration were incubated in sperm preparation medium.

MAIN OUTCOME MEASURE(S)

Sperm quality by PVSA and pregnancy outcome.

RESULT(S)

Thirty-four PVSA-IUI procedures were performed in 26 men with anejaculation. Nineteen pregnancies were achieved (pregnancy rate, 73.1%). Mean (+/-SD) values for sperm variables were as follows: motility, 78.6% +/- 14.2%; progressive motility, 60.4% +/- 11.2%; density, 37.6 +/- 13.2 x 10(6) cells/mL; total count, 35.2 +/- 13.2 x 10(6) cells; and abnormal sperm, 18.6% +/- 7.6%.

CONCLUSION(S)

Percutaneous vasal sperm aspiration may obtain high-motility sperm, and PVSA plus IUI is an effective treatment for male infertility with anejaculation.

Update on medical treatment of ejaculatory disorders

Among the treatment modalities for ejaculatory disorders pharmacological treatment is the least invasive option. In this review, medical treatments for retrograde ejaculation (RE) and anejaculation (AE) are discussed systematically. Thirty-six studies dealing with patients with RE and 40 with AE evaluated the use of medical treatment and were included in this review. In addition four articles dealing with prostatic massage in anejaculatory patients were considered. Sperm quality in patients with retrograde and AE is often impaired. In patients with RE no differences in response to medical treatment could be detected between the different underlying diagnoses. Compared with ephedrine, imipramine and chlorpheniramine + phenylpropanalamine showed significantly higher reversal rates, while differences between the other treatments were not significant. Regarding the reversal of AE, the alpha agonistic drugs were significantly inferior to treatment with parasympathetic drugs. Of the different alpha agonistic medical treatments for the reversal of AE, milodrin showed significantly better rates than imipramine (p = 0.008), pseudoephidrine (p = 0.02) and ephedrine (p = 0.044), while all other treatments were not significantly different (p = 0.4). In conclusion, medical treatment for reversal of RE offers a realistic chance of conceiving offspring naturally and should be the treatment modality of first choice. In contrast, in AE, medical treatment cannot be recommended generally as treatment of first choice as it shows low overall success rates compared with electrovibration stimulation and electroejaculation. Under consideration of the mostly uncontrolled design of the majority of studies published, controlled clinical trials comparing different treatment options appear urgently warranted.

Diagnosis and treatment of ejaculatory dysfunction

The normal ejaculatory process requires complex coordination and integration of neurologic, physiologic, anatomic, and psychologic events. An understanding of these processes is critical to evaluate properly and manage patients with ejaculatory dysfunction. With the advent of improved techniques to treat patients, some men with ejaculatory dysfunction are being offered the opportunity to reproduce. Further research on the ejaculatory process and associated dysfunctional states should continue to improve treatment for patients presenting with ejaculatory disorders.