Nocturnal sperm emission in men with psychogenic anejaculation

Sex, ducks, and rock "n" roll: Mathematical model of sexual response

In this paper, we derive and analyze a mathematical model of a sexual response. As a starting point, we discuss two studies that proposed a connection between a sexual response cycle and a cusp catastrophe and explain why that connection is incorrect but suggests an analogy with excitable systems. This then serves as a basis for derivation of a phenomenological mathematical model of a sexual response, in which the variables represent levels of physiological and psychological arousal. Bifurcation analysis is performed to identify stability properties of the model's steady state, and numerical simulations are performed to illustrate different types of behavior that can be observed in the model. Solutions corresponding to the dynamics associated with the Masters-Johnson sexual response cycle are represented by "canard"-like trajectories that follow an unstable slow manifold before making a large excursion in the phase space. We also consider a stochastic version of the model, for which spectrum, variance, and coherence of stochastic oscillations around a deterministically stable steady state are found analytically, and confidence regions are computed. Large deviation theory is used to explore the possibility of stochastic escape from the neighborhood of the deterministically stable steady state, and the methods of an action plot and quasi-potential are employed to compute most probable escape paths. We discuss implications of the results for facilitating better quantitative understanding of the dynamics of a human sexual response and for improving clinical practice.

Electroejaculation combined with assisted reproductive technology in psychogenic anejaculation patients refractory to penile vibratory stimulation

Background

Psychogenic anejaculation (PAE) is a rare disease in clinic seriously affecting quality of life, especially fertility of patients. However, there is not an effective treatment for these patients. The aim of the study was to evaluate the results of treatment with electroejaculation (EEJ), intrauterine insemination (IUI), and intracytoplasmic sperm injection (ICSI) in patients with PAE who were refractory to penile vibratory stimulation (PVS).

Methods

Twenty PVS-refractory patients with PAE were included in the retrospective study. Semen was retrieved through EEJ procedures. According to the semen quality and patient preference, IUI or ICSI was selected.

Results

A total of 23 procedures of EEJ were performed in 20 patients. Sperm was successfully retrieved in all of the cases. Yielded semen was used in a total of 16 ICSI procedures in 6 couples. The fertilization rate was 54.0%. The ICSI cycles resulted in three pregnancies; of these one resulted in a live birth. Fourteen couples were treated with 26 IUI cycles, which resulted in live births in five pregnancies.

Conclusions

EEJ offers an encouraging pregnancy opportunity for men with PAE who were refractory to PVS. The combined use of EEJ and assisted reproductive techniques is excellent management for PAE infertility. In our study, EEJ resulted in pregnancies and the birth of six healthy children.

Effect of Varicocelectomy on the Frequency of Nocturnal Sperm Emissions

The aim of this study was to investigate the frequency of nocturnal sperm emissions (NSE) in varicocele patients after varicocele surgery. A total of 127 patients, 96 varicocele (Group 1) and 31 patients with inguinal hernia (Group 2) were included in this study. Mean age, laterality of surgical procedures, spermiogram results, marital status, and postoperative serum hormone levels were noted for all patients. Two groups were compared in terms of Beck depression score (BDS) and anxiety scores (AS). The frequency of NSE and libido changes in the patients during 10 days postoperatively was evaluated. The number of the patients who had NSE and increased libido were significantly higher in the varicocelectomy group when compared with the control group. No significant difference was noted between the groups in terms of BDS, AS, and serum hormone levels. No association was reported between BDS, AS, and serum hormone levels and the presence of NSE in Group 1. The incidence of NSE was higher in younger men. Increased libido was significantly associated with NSE in Group 1. Cord dissection during surgery may be a factor on increased frequency of NSEs in varicocele patients.

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.

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.

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.

Ejaculatory physiology and dysfunction

The sequence of events encompassing ejaculation has been well described. Multiple disease processes can result in ejaculatory dysfunction. Evaluation and subsequent treatment of ejaculatory dysfunction is possible using behavioral, mechanical, and medical and surgical modalities. Further elucidation of ejaculation is now taking place at the molecular level.