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

Sperm retrieval techniques

Since the advent of intracytoplasmic sperm injection in 1992, sperm retrieval procedures have been routinely employed to treat male infertility owing to azoospermia. With obstructive azoospermia, sperm is potentially harvestable from the vas deferens, epididymis, and testicle using percutaneous and open sperm retrieval procedures that are relatively straightforward and reliable. In nonobstructive azoospermia, sperm is generally found only in the testicles and can often be difficult to retrieve. Several approaches aimed at maximizing sperm yield in this condition have been developed, but only 50% of men with nonobstructive azoospermia will have clinically usable sperm. Multibiopsy testicular sperm extraction (TESE), microdissection TESE, and fine-needle-aspiration map-guided TESE are three common methods currently employed to locate and retrieve sperm in these difficult cases. Other factors that influence the use of surgically retrieved sperm for assisted reproduction include differences in sperm DNA integrity, the expertise of the surgeon and the andrology laboratory, and the described differences in the viability of sperm from different anatomical sources after freezing and thawing.

Measurement of sexual functioning after spinal cord injury: preferred instruments

BACKGROUND/OBJECTIVE

To determine the utility of certain instruments to assess sexuality and fertility after SCI, an expert panel identified key areas to study and evaluated available instruments. These were rated according to certain predefined criteria.

METHODS

The authors divided sexual issues into male and female sexual function, male reproductive function, and female reproductive function. The instruments that have been used most frequently to measure these aspects of sexual function over the past 5 years were identified by expert consensus. Finally, these instruments were subjected to a critical review.

RESULTS

The Female Sexual Function Index (FSFI), measurement of vaginal pulse amplitude (VPA), the International Index of Erectile Function (IIEF), and the measurement of ejaculatory function and semen quality were considered appropriate measures to assess sexual responses and reproductive function after SCI. There were no measures identified to assess female reproductive function.

CONCLUSIONS

For clinical trials aiming to improve sexual function after SCI, the FSFI or the IIEF is currently preferred. Although VPA is an appropriate means to assess female sexual responses, it is only useful for laboratory studies and is too invasive for use in clinical trials. For assessment of male fertility potential, assessment of ejaculatory capacity and semen analysis are recommended.

Combined use of phosphodiesterase-5 inhibitors and selective serotonin reuptake inhibitors for temporary ejaculation failure in couple undergoing assisted reproductive technologies

OBJECTIVE

To explore the drug treatment for temporary ejaculation failure in couple undergoing assisted reproductive technologies (ART).

DESIGN

Case report.

SETTING

Andrology unit, center for reproductive medicine.

PATIENT (S)

Five patients suffering from temporary ejaculation failure during ART.

INTERVENTION(S)

Assisted reproductive technology. Semen samples were collected by masturbation. The combined use of phosphodiesterase-5 inhibitor (PDE5-I; vardenafil, 10 mg) and selective serotonin reuptake inhibitor (SSRI; sertraline, 50 mg) to treat patients who failed to collect semen on the day of egg retrieval.

RESULT(S)

Five patients with unexpected ejaculation failure during ART treatments were identified; two patients could not produce spermatozoa 3 h after taking PDE5-I (sildenafil, 50 mg), However, the use of PDE5-I (vardenafil, 10 mg) plus SSRI (sertraline, 50 mg) enabled them to provide spermatozoa successfully. It suggested that the combined protocol could be more efficient for temporary ejaculation failure than sildenafil alone. On the day of the egg retrieval, we directly prescribed vardenafil and sertraline for the other three patients and got sperm samples without difficulty 2 h later.

CONCLUSION(S)

The results indicate that the combined protocol of vardenafil plus sertraline could resolve the unpredictable ejaculation failure during ART. We presume that it might be helpful for attenuating the patients' stress and anxiety.

Current trends in the treatment of infertility in men with spinal cord injury

OBJECTIVE

To determine current use of penile vibratory stimulation (PVS), electroejaculation (EEJ), and intrauterine insemination (IUI) in treatment of infertility in men with spinal cord injury (SCI).

DESIGN

Prospective survey, retrospective chart review, and literature review.

SETTING

Major university medical center.

PATIENT(S)

Male SCI patients and female partners.

INTERVENTION(S)

A survey administered to professionals determined current treatment methods for infertility in couples with SCI male partners.

MAIN OUTCOME MEASURE(S)

Sperm retrieval methods, ejaculation success rates, total motile sperm (TMS), IUI application, and IUI outcomes.

RESULT(S)

Twenty-eight percent of surveyed professionals do not retrieve sperm from ejaculates of SCI patients, relying instead on retrieval from reproductive tissues. Reasons for not offering PVS or EEJ were lack of familiarity, training, or equipment. Thirty-four percent do not offer IUI to these couples. Chart review showed that semen could be retrieved by PVS or EEJ in 95% of patients. Fifty-three percent and 43% of trials had TMS >5 and >10 x 10(6), respectively. Of survey respondents performing IUI, 42% lacked enough data to estimate pregnancy rates (PRs) in these couples. Literature review showed IUI PRs between 9% and 18% per cycle and 30% and 60% per couple.

CONCLUSION(S)

Based on ejaculation success rates, TMS yields, and IUI outcomes, the methods of PVS, EEJ, and IUI warrant consideration in centers not currently offering these options for couples with SCI male partners.