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Capogrosso P, Jensen CFS, Rastrelli G, Torremade J, Russo GI, Raheem AA, Frey A, Fode M, Maggi M, Reisman Y, Bettocchi C, Corona G. Male Sexual Dysfunctions in the Infertile Couple-Recommendations From the European Society of Sexual Medicine (ESSM). Sex Med 2021; 9:100377. [PMID: 34090242 PMCID: PMC8240351 DOI: 10.1016/j.esxm.2021.100377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/31/2021] [Accepted: 04/03/2021] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION Sexual dysfunctions (SDs) have been frequently reported among male partners of infertile couples due to psychogenic, relational and/or organic issues related with the inability to conceive. Likewise, male infertility (MI) could be a consequence of sexual dysfunctions. AIM To review the evidence on the prevalence and treatment of male SDs in men of infertile couples and provide clinical recommendations on behalf of the European Society of Sexual Medicine (ESSM). METHODS The MEDLINE database was searched in September 2019 for randomized clinical trials (RCTs), meta-analyses and open-label prospective or retrospective studies investigating the presence of erectile dysfunction (ED) and/or ejaculatory dysfunctions (EjDs) and/or low sexual desire (LSD) in conjunction with infertility. MAIN OUTCOME MEASURE The panel provided statements on: (i) Prevalence and association between SDs and MI; (ii) Treatment of male SDs in men of infertile couples. RESULTS ED has been reported in 9% to 62% of male partners of infertile couples, with severe impairment observed in only 1% to 3% of ED cases. Moreover, worse semen parameters have been associated with greater ED severity. Phosphodiesterase type 5 inhibitors (PDE5is) can be safely used to treat ED among patients seeking fatherhood. Male partners of infertile couples are at higher risk of premature ejaculation (PE). Retrograde ejaculation (RE) and anejaculation are a cause of MI and can be managed with electroejaculation (EEJ) or penile vibratory stimulation (PVS) or, alternatively, with oral treatments, however the latter with limited documented success. Low sexual desire has been reported by one third of men of infertile couples. CONCLUSION ED could significantly affect male partners of infertile couple; PDE5is should be suggested to ensure an effective and satisfactory sexual relationship of the couple. Anejaculation and RE should be considered as a possible cause of MI and treated accordingly. Low sexual desire is frequently reported among men of infertile couple and could be a symptom of other systemic conditions or psychological distress. Capogrosso P, Jensen CFS, Rastrelli G, et al. Male Sexual Dysfunctions in the Infertile Couple-Recommendations From the European Society of Sexual Medicine (ESSM). J Sex Med 2021;9:100377.
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Affiliation(s)
- Paolo Capogrosso
- Department of Urology, Circolo & Fondazione Macchi Hospital, University of Insubria, Varese, Italy.
| | | | - Giulia Rastrelli
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | | | | | - Amr Abdel Raheem
- Department of Andrology, The Institute of Urology, University College London Hospitals, London, UK
| | - Anders Frey
- Department of Urology, University of Southern Denmark, Esbjerg, Odense
| | - Mikkel Fode
- Department of Urology, Zealand University Hospital, Roskilde; Department of Clinical Medicine, University of Copenhagen
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence
| | - Yacov Reisman
- Men's Health Clinic, Amstelland Hospital, Amsterdam, The Netherlands
| | - Carlo Bettocchi
- Division of Urology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda USL, Maggiore-Bellaria Hospital, Bologna, Italy
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Gerstl B, Bertoldo MJ, Sullivan E, Volckmar X, Kerr A, Wand H, Ives A, Albalawi O, Anazodo A. Fatherhood Following Treatment for Testicular Cancer: A Systematic Review and Meta-Analyses. J Adolesc Young Adult Oncol 2020; 9:341-353. [DOI: 10.1089/jayao.2019.0164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brigitte Gerstl
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
- Kids Cancer Center, Sydney Children's Hospital, Sydney, Australia
| | - Michael J. Bertoldo
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Elizabeth Sullivan
- Faculty Health and Medicine, The University of Newcastle, Newcastle, Australia
| | - Xanthie Volckmar
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Aidan Kerr
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Handan Wand
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Angela Ives
- Cancer and Palliative Care Research and Evaluation Unit, University of Western Australia, Crawley, Australia
| | - Olayan Albalawi
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Statistics, Science College, Tabuk University, Tabuk, Saudi Arabia
| | - Antoinette Anazodo
- Kids Cancer Center, Sydney Children's Hospital, Sydney, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- Nelune Comprehensive Cancer Center, Prince of Wales Hospital, Sydney, Australia
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Mehta A, Sigman M. Management of the dry ejaculate: a systematic review of aspermia and retrograde ejaculation. Fertil Steril 2015; 104:1074-81. [DOI: 10.1016/j.fertnstert.2015.09.024] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 09/10/2015] [Accepted: 09/16/2015] [Indexed: 01/23/2023]
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Chiba K, Fujisawa M. Fertility preservation in men with cancer. Reprod Med Biol 2014; 13:177-184. [PMID: 29662373 DOI: 10.1007/s12522-014-0180-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 04/07/2014] [Indexed: 12/23/2022] Open
Abstract
Due to recent advances in medical technologies, cancer has become more curable and chronic, and post-treatment quality of life, including male fertility, has become an important issue. Cancer itself can affect spermatogenesis through complex interactions, and cancer treatment such as surgery, radiotherapy and chemotherapy, all have certain detrimental effects on spermatogenesis. Currently, sperm cryopreservation before cancer treatment is the mainstay of fertility preservation, and is recommended by numerous guidelines. Although fertility preservation should be discussed with all cancer patients before treatment, it still remains underused. Postpubertal patients who are unable to bank sperm may undergo testicular sperm extraction before treatment. For prepubertal boys, there is no clinically established guideline for fertility preservation. Investigations such as spermatogonial stem cell culture are ongoing, and may lead to clinical options for fertility preservation in the future.
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Affiliation(s)
- Koji Chiba
- Division of Urology, Department of Surgery Related, Faculty of Medicine Kobe University Graduate School of Medicine 7-5-1 Kusunoki-Cho, Chuo-Ku 650-0017 Kobe Japan
| | - Masato Fujisawa
- Division of Urology, Department of Surgery Related, Faculty of Medicine Kobe University Graduate School of Medicine 7-5-1 Kusunoki-Cho, Chuo-Ku 650-0017 Kobe Japan
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Mitwally MFM. Fertility preservation and minimizing reproductive damage in cancer survivors. Expert Rev Anticancer Ther 2014; 7:989-1001. [PMID: 17627459 DOI: 10.1586/14737140.7.7.989] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Recent advances in oncology have helped in the survival and cure of increasing numbers of childhood cancer patients and those during their reproductive age period. This has increased the need to improve existing technology, and prompted the search for new technologies, to minimize the gonadotoxic effects of cancer treatment and preserve human fertility. Conservative surgical approaches for cancer treatment have been widely accepted following progress in early detection of cancer and accumulating long-term outcome safety data. Gonadal suppression to increase resistance to cancer treatment by gonadotropin analogues and sex hormones has been suggested. However, while this is unlikely to be effective in males, there is no general consensus on its success in the female. Fertility preservation options for both male and female patients include cryopreservation of embryos, gametes and gonads. While embryo cryopreservation is a well-established and successful technique, there are several obvious limitations. Gamete cryopreservation is very successful in males (sperm freezing) while still experimental in females (oocyte freezing), with growing evidence suggesting its potential success. Gonadal cryopreservation is still in its early stages of experimental development, both in males (testicular tissue cryopreservation and in vitro spermatogenesis) and female (ovarian tissue cryopreservation and in vitro follicular maturation).
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Jefferys A, Siassakos D, Wardle P. The management of retrograde ejaculation: a systematic review and update. Fertil Steril 2011; 97:306-12. [PMID: 22177462 DOI: 10.1016/j.fertnstert.2011.11.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 11/12/2011] [Accepted: 11/15/2011] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the best management of retrograde ejaculation to optimize the chance of conception. DESIGN Systematic review. SETTING Tertiary reproductive medicine center. PATIENT(S) Subfertile men with retrograde ejaculation. METHOD(S) Systematic search of studies using search terms "management" or "therapy" or "treatment" and "retrograde ejaculation." We excluded case reports and papers not in English. MAIN OUTCOME MEASURE(S) Pregnancy and live birth rates and rates of achievement of antegrade ejaculation. RESULT(S) Thirty-four studies met our criteria. Studies were mostly observational. Descriptions of predictive and confounding variables were often insufficient. The treatment options included urinary sperm retrieval and medical management with anticholinergics and sympathomimetics. Successful pregnancies and live births were also achieved using surgical techniques and electroejaculation; however, numbers were small. CONCLUSION(S) Many treatment options exist in the management of retrograde ejaculation; however, current literature is insufficient to allow firm comparisons between interventions. Treatment should be tailored, therefore, to the individual. Our findings support the need for further research in this area-including large randomized controlled trials. However, these would be difficult logistically and may not be possible.
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Affiliation(s)
- Amanda Jefferys
- Department of Women's Health, Southmead Hospital, Bristol, United Kingdom.
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Bringer-Deutsch S, Belaisch-Allart J, Delvigne A. Préservation de la fertilité en cas de traitement stérilisant. ACTA ACUST UNITED AC 2010; 39:S53-66. [DOI: 10.1016/s0368-2315(10)70031-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Lee SJ, Schover LR, Partridge AH, Patrizio P, Wallace WH, Hagerty K, Beck LN, Brennan LV, Oktay K. American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol 2006; 24:2917-31. [PMID: 16651642 DOI: 10.1200/jco.2006.06.5888] [Citation(s) in RCA: 1307] [Impact Index Per Article: 72.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To develop guidance to practicing oncologists about available fertility preservation methods and related issues in people treated for cancer. METHODS An expert panel and a writing committee were formed. The questions to be addressed by the guideline were determined, and a systematic review of the literature from 1987 to 2005 was performed, and included a search of online databases and consultation with content experts. RESULTS The literature review found many cohort studies, case series, and case reports, but relatively few randomized or definitive trials examining the success and impact of fertility preservation methods in people with cancer. Fertility preservation methods are used infrequently in people with cancer. RECOMMENDATIONS As part of education and informed consent before cancer therapy, oncologists should address the possibility of infertility with patients treated during their reproductive years and be prepared to discuss possible fertility preservation options or refer appropriate and interested patients to reproductive specialists. Clinician judgment should be employed in the timing of raising this issue, but discussion at the earliest possible opportunity is encouraged. Sperm and embryo cryopreservation are considered standard practice and are widely available; other available fertility preservation methods should be considered investigational and be performed in centers with the necessary expertise. CONCLUSION Fertility preservation is often possible in people undergoing treatment for cancer. To preserve the full range of options, fertility preservation approaches should be considered as early as possible during treatment planning.
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Patel MI, Motzer RJ, Sheinfeld J. Management of recurrence and follow-up strategies for patients with seminoma and selected high-risk groups. Urol Clin North Am 2004; 30:803-17. [PMID: 14680316 DOI: 10.1016/s0094-0143(03)00063-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Seminoma is characterized by high sensitivity to both radiation and chemotherapy. Localized recurrences in the retroperitoneum after surveillance for stage I can be treated with radiotherapy; however, multiple or large bulky retroperitoneal recurrences or systemic metastasis requires cisplatin-based chemotherapy. Salvage chemotherapy for those who recur after initial CR to induction chemotherapy is based on ifosfamide- and cisplatin-containing regimens. Incomplete response or failure after induction chemotherapy requires high-dose chemotherapy and stem cell rescue. Patients with seminoma need long-term follow-up because of the possibility of late recurrence and the risk of a second primary tumor.
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Affiliation(s)
- Manish I Patel
- Department of Urology, Memorial Sloan-Kettering Cancer Center, 353 E. 68th Street, New York, NY 10021, USA
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Turek PJ, Lowther DN, Carroll PR. Fertility issues and their management in men with testis cancer. Urol Clin North Am 1998; 25:517-31. [PMID: 9728221 DOI: 10.1016/s0094-0143(05)70041-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Although a curable malignancy, testis cancer and its treatment have unique associated morbidities that largely affect reproductive dysfunction. In this focused review, the factors that contribute to infertility in men with testis cancer are outlined. The treatment-specific risks to fertility that accompany cancer management are also discussed. Contemporary methods of overcoming infertility in testis cancer patients are addressed, and several exciting and promising experimental approaches to the preservation or restoration of fertility for men with testis cancer are presented.
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Affiliation(s)
- P J Turek
- Department of Urology, University of California San Francisco, USA
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Barros A, Sousa M, Andrade MJ, Oliveira C, Silva J, Beires J. Birth after electroejaculation coupled to intracytoplasmic sperm injection in a gun-shot spinal cord-injured man. ARCHIVES OF ANDROLOGY 1998; 41:5-9. [PMID: 9642453 DOI: 10.3109/01485019808988538] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We describe the case of a man who, after a gun-shot wound, has become paraplegic. As a consequence of his spinal cord injury he developed infertility due to incomplete erection and anejaculation. After several unsuccessful penile vibratory stimulation attempts, it was possible to achieve ejaculation by means of transrectal electrostimulation. However, the total sperm motility count, the percentage of normal sperm morphology, and the vitality and hypo-osmotic swelling test scores were rather low, and in particular viability was strikingly decreased during sperm preparation. These parameters further decreased following electroejaculate, forcing us to use intracytoplasmic sperm injection instead of conventional in vitro fertilization for the treatment cycle. A normal pregnancy was achieved which resulted in birth of a healthy girl on 1st January 1997.
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Affiliation(s)
- A Barros
- Department of Medical Genetics, Faculty of Medicine, University of Porto, Portugal
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Nagai S, Kasai T, Ogawa K, Mizuno K, Ohta S, Hoshi K. Successful treatment of infertility due to anejaculation with in vitro fertilization and embryo transfer: a report of two cases. TOHOKU J EXP MED 1998; 184:241-6. [PMID: 9591339 DOI: 10.1620/tjem.184.241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We investigated the efficacy of assisted ejaculation in combination with in vitro fertilization and embryo transfer (IVF-ET) in two couples with infertility due to anejaculation. Case 1 was in an anejaculatory condition associated with a spinal cord-injury. We performed intrauterine insemination (IUI) three times using motile sperm obtained by intrathecal injection of neostigmine, but no pregnancy followed. The couple then entered IVF-ET. The semen volume obtained by assisted ejaculation was 4.5 ml. The sperm count was 33 x 10(6)/ml with 33% motility. At 35 weeks of gestation she delivered three healthy babies by cesarean section. Case 2 was in an unexplained retrograde ejaculatory condition. We performed IUI eight times before changing to IVF-ET. We then used sperm obtained from urine or sperm recovered from the bladder after administration of human tubal fluid, but no pregnancy followed. At the fifth IVF-ET attempt, using sperm obtained from urine, we succeeded. We prepared the sperm by the Percoll gradient method. The sperm count was 36 x 10(6)/ml with 64% motility. At 39 weeks of gestation she delivered a healthy baby. Deficient seminal quality contributes to the decreased fertility potential in patients with anejaculation. With the use of IVF-ET methods, pregnancies can be achieved in these couples.
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Affiliation(s)
- S Nagai
- Department of Obstetrics and Gynecology, Yamanashi Medical University, Japan.
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