Electroejaculation in combination with intracytoplasmic sperm injection in patients with psychogenic anejaculation results in lower fertilization rates

Two cases of psychogenic anejaculation patients got normal ejaculation ability after penile vibratory stimulation or electroejaculation

Psychogenic anejaculation is a unique problem which accounts for 0.4-0.5% of anejaculation patients. Although patients with this problem may experience erections and nocturnal emissions (NEs), they do not experience ejaculation during either masturbation or coitus. The etiology is presently unknown. Penile vibratory stimulation (PVS) and electroejaculation (EEJ) have been the main methods of sperm retrieval for psychogenic anejaculation couples undergoing assisted reproduction technology (ART). However, there is no special treatment which can heal psychogenic anejaculation patients. Here, we report two psychogenic anejaculation patients who recovered normal ejaculation ability after PVS or EEJ procedure.

Electroejaculation in psychogenic anejaculation

OBJECTIVE

To evaluate the results of treatment with electroejaculation (EEJ), intrauterine insemination (IUI), and IVF/intracytoplasmic sperm injection (IVF/ICSI) in patients with psychogenic anejaculation (PAE).

DESIGN

Retrospective clinical study.

SETTING

Academic tertiary referral fertility center.

PATIENT(S)

Eleven male patients diagnosed with psychogenic anejaculation (PAE) were included. Median age at the time of first treatment with EEJ was 33.0 (interquartile range, 29.0-36.0) years.

INTERVENTION(S)

Electroejaculation, IUI, and IVF/ICSI.

MAIN OUTCOME MEASURE(S)

Semen analysis, fertilization rate, implantation rate, pregnancy rate, and delivery rate.

RESULT(S)

A total of 60 EEJs were performed in 11 patients. Mean VCM (volume [mL] × concentration [sperm cells/mL] × percentage progressive motile cells) of the retrieved sperm of all EEJs was 17.5 × 10(6) (SD 16.5 × 10(6)). Yielded semen was used in a total of 26 ICSI procedures in seven couples. The fertilization rate was 65.6% (80 of 122). The ICSI cycles resulted in five pregnancies; of these, one resulted in a spontaneous abortion in the first trimester. Three couples were treated with 34 IUI cycles, which resulted in live births in four pregnancies.

CONCLUSION(S)

Electroejaculation is a suitable and effective treatment that can be used in men with psychogenic anejaculation. The retrieved semen can be used successfully in assisted reproductive technology treatment. In this study EEJ resulted in pregnancies and the birth of eight healthy children.

Fresh semen quality in ejaculates produced by nocturnal emission in men with idiopathic anejaculation

OBJECTIVE

To compare the quality of fresh semen samples collected by nocturnal emission (NE), penile vibratory stimulation (PVS), or electroejaculation (EEJ) from idiopathic anejaculation patients with those collected by masturbation from healthy control subjects.

DESIGN

Retrospective clinical study.

SETTING

University medical center.

PATIENT(S)

Ninety-one men with idiopathic anejaculation.

INTERVENTION(S)

NE, PVS, EEJ, computer-assisted semen analysis system.

MAIN OUTCOME MEASURE(S)

Sperm volume, concentration, motility, and morphology.

RESULT(S)

The mean percentage of motile sperm in the NE group was 30.6% ± 3.5% (range 11.2%-50.9%), which is 1.5- and 1.9-fold higher than that of the PVS (20.5% ± 1.3%, range 6.9%-40.2%) and EEJ (16.1% ± 0.9%, range 3.7%-27.3%) groups, respectively. The percentage of sperm that have normal morphology in the NE group was 61.4% ± 4.8%, which is significantly higher than that in the PVS (38.4% ± 2.8%) and EEJ groups (29.5% ± 1.7%), respectively. However, compared with the healthy control group, the sperm motility and normal morphology in the NE, PVS, and EEJ groups were significantly lower. The sperm concentration in the NE group (149.4 ± 16.3 × 10(6) mL(-1)) was similar to that of the PVS group (143.8 ± 13.1 × 10(6) mL(-1)) but was higher than in the EEJ group (96.3 ± 8.6 × 10(6) mL(-1)) and lower than in the control group (225.0 ± 15.0 × 10(6) mL(-1)). Furthermore, the semen volume in the NE group (2.6 ± 0.2 mL) was lower than that of the control group (3.0 ± 0.1 mL).

CONCLUSION(S)

This study is the first to report on the quality of fresh semen obtained by NE in patients with idiopathic anejaculation. Sperm motility and normal morphology were higher in patients who collected sperm by NE than in those who collected sperm by PVS and EEJ.

Electroejaculation combined with intracytoplasmic sperm injection in patients with psychogenic anejaculation yields comparable results to patients with spinal cord injuries

OBJECTIVE

To evaluate sperm quality and fertility potential of men with psychogenic anejaculation treated by electroejaculation (EEJ) and intracytoplasmic sperm injection (ICSI). Treatment results were compared to spinal cord injured (SCI) patients treated similarly.

DESIGN

Retrospective clinical study.

SETTING

Academic tertiary referral fertility center.

PATIENT(S)

Couples with isolated psychogenic anejaculation or SCI.

INTERVENTION(S)

Electroejaculation and ICSI.

MAIN OUTCOME MEASURE(S)

Semen analysis, fertilization rate, implantation rate, pregnancy rate, delivery rate and safety of the procedure.

RESULT(S)

Fifteen patients diagnosed with psychogenic anejaculation underwent 40 EEJ/ICSI cycles. The semen retrieved was characterized by low motility (mean 10.7% ± 12.3%), normal volume (2.2 ± 1.9 mL) and normal count (25.1 ± 29.9 × 10(6)/mL), according to World Health Organization criteria. Results of EEJ/ICSI were compared with 22 SCI patients treated by 66 EEJ/ICSI cycles during the same period. Mean female age and the number of oocytes retrieved per cycle were similar between the groups. Similar semen parameters after EEJ were found between psychogenic and SCI patients. Fertilization rate was significantly lower in the psychogenic patients compared to SCI (47.0% and 57.0%, respectively). No significant differences were found regarding pregnancy rates (20% and 22.7%, respectively), implantation rate (10.2% and 11.6%, respectively) or delivery rates (15% and 18.2%, respectively).

CONCLUSION(S)

Sperm retrieved by EEJ is characterized by asthenospermia and normal count. In spite of the lower fertilization rate in psychogenic patients, combination of EEJ and ICSI gives adequate results to couples with psychogenic anejaculation similar to the results obtained for SCI patients. Current results give these couples a reasonable chance of pregnancy achievement.

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).

No-scalpel vasal sperm aspiration and in vitro fertilization for the treatment of anejaculation

OBJECTIVES

To evaluate the utility of no-scalpel vasal sperm aspiration and in vitro fertilization for the treatment of male infertility due to anejaculation.

METHODS

Vasal aspiration was performed using a no-scalpel technique, and the sperm were used for conventional in vitro fertilization in 1 patient and intracytoplasmic sperm injection in 6 patients.

RESULTS

The average total sperm count was 6 x 10(6), with the motility between 20% and 95%. No complications have been observed to date. A high fertilization rate (74.6%) and pregnancy rate (5 of 7) was achieved with subsequent intracytoplasmic sperm injection or in vitro fertilization.

CONCLUSIONS

No-scalpel vasal sperm aspiration is a simple, effective alternative to sperm retrieval, especially for anejaculatory males.