Gabapentin for Postoperative Pain Control and Opioid Reduction in Scrotal Surgery: A Randomized Controlled Clinical Trial.

PURPOSE: To assess the safety and efficacy of gabapentin in reducing postoperative pain among patients undergoing scrotal surgery for male infertility by conducting a randomized, double-blind, placebo-controlled trial. MATERIALS AND METHODS: In this randomized, double-blind, placebo-controlled trial, healthy men undergoing scrotal surgery with a single surgeon were randomized to receive either (1) gabapentin 600 mg given 2 hours preoperatively and 300 mg taken 3 times a day postoperatively for 3 days, or (2) inactive placebo. The primary outcome measure was difference in postoperative pain scores. Secondary outcomes included differences in opioid usage, patient satisfaction, and adverse events. RESULTS: Of 97 patients screened, 74 enrolled and underwent randomization. Of these, 4 men were lost to follow-up, and 70 were included in the final analysis (35 gabapentin, 35 placebo). Both differences in initial postoperative mean pain score (-1.14, 95% CI -2.21 to -0.08, P = .035) and final mean pain score differences (-1.27, 95% CI -2.23 to -0.32, P = .0097) indicated lower gabapentin pain compared to placebo. There were no statistically significant differences in opioid usage, patient satisfaction, or adverse events. CONCLUSIONS: These data suggest that perioperative gabapentin results in a statistically and clinically significant decrease in pain following scrotal surgery. While there was no evidence of an impact on opioid usage or patient satisfaction, given the low risk of adverse events, it may be considered as part of a multimodal pain management strategy.

Optimizing outcomes for men with severe infertility.

PURPOSE OF REVIEW: To evaluate recent evidence related to optimizing outcomes for men with severe infertility, including effect of ejaculatory abstinence interval on semen parameters and assisted reproductive technology (ART) outcomes, and impact of cryopreservation on surgically retrieved testicular sperm obtained from men with nonobstructive azoospermia (also referred to as azoospermia due to spermatogenic dysfunction). RECENT FINDINGS: Recent evidence strongly suggests that a short abstinence interval improves sperm motility and ART outcomes. Similarly, recent studies have concluded that using fresh vs. frozen testicular sperm results in higher live birth rates. SUMMARY: Although the World Health Organization currently recommends a 2- to 7-day ejaculatory abstinence period, this interval is based more on the need to standardize semen parameters than clinical outcomes. In fact, recent evidence suggests that shorter abstinence consistently improves sperm motility and ART outcomes for infertile men. Similarly, recent studies have reported an improvement in live birth rates with fresh (vs. frozen) testicular sperm, though their retrospective design and lack of intention to treat analyses makes it difficult to draw strong conclusions. Although additional, well designed studies are needed, providers may be able to leverage these techniques in their practice to improve outcomes for some infertile men.

Sperm DNA Damage and Its Relevance in Fertility Treatment: A Review of Recent Literature and Current Practice Guidelines.

Sperm deoxyribonucleic acid (DNA) damage has recently emerged as one of the most controversial topics in male reproductive medicine. While level I evidence indicates that abnormal sperm DNA damage has substantial adverse effects on reproductive outcomes (including chance of pregnancy and risk of miscarriage), there is limited consensus on how sperm DNA fragmentation (SDF) testing should be performed and/or interpreted in clinical practice. In this article, we review: (1) how SDF is assessed, (2) cumulative evidence regarding its impact on reproductive outcomes, (3) methods for mitigating high SDF, and (4) the most recent practice guidelines available for clinicians regarding the use and interpretation of SDF testing.

Sperm DNA fragmentation and its interaction with female factors.

High levels of sperm deoxyribonucleic acid (DNA) fragmentation have been associated with adverse reproductive outcomes, including low natural and assisted pregnancy rates, abnormal embryonic development, and recurrent pregnancy loss. These poor outcomes are likely caused by unrepaired DNA damage exceeding a critical repair threshold, adversely affecting normal embryo development. In these cases, DNA repair mechanisms of the oocyte may play a significant role in compensating for sperm DNA damage, preserving normal embryo development, and enhancing reproductive outcomes.

Can semen parameters predict pregnancy outcomes?

Semen analysis is an integral component of the evaluation and management of men with infertility. Although it is important for patient counseling and clinical decision making, a conventional semen analysis cannot reliably predict the chance of pregnancy or differentiate fertile vs. infertile men (except in the most extreme cases). Advanced, nonstandard sperm functional tests may provide additional discriminatory and prognostic power; however, further research is needed to determine how to best incorporate these tests into modern clinical practice. Therefore, the primary applications of a conventional semen analysis should be to judge the severity of infertility, estimate the effects of future therapy, and measure the response to current therapy.

Successful cryptozoospermia management with multiple semen specimen collection.

OBJECTIVE: To determine the prevalence of sperm suitable for intracytoplasmic sperm injection (ICSI) in fresh ejaculated semen samples provided by men scheduled for a microdissection testicular sperm extraction (mTESE) procedure. Secondary objectives included an evaluation of the effect of a short abstinence period on semen quality and ICSI outcomes for men with cryptozoospermia. DESIGN: Retrospective cohort study. SETTING: Academic medical center. PATIENTS: All men were scheduled to undergo a mTESE procedure by a single, high-volume surgeon at an academic center from September 1, 2015, to May 1, 2021. INTERVENTION: Presence of sperm suitable for ICSI in the ejaculate on the day of scheduled mTESE. MAIN OUTCOME MEASURES: Prevalence of sperm suitable for ICSI in the ejaculate among previously diagnosed men with azoospermia. Secondary outcomes included changes in semen parameters, clinical pregnancy rate, and live birth rate. RESULTS: Of 727 planned mTESE procedures, 69 (9.5%) were canceled because sperm suitable for ICSI were identified in a fresh ejaculated sample produced on the day of scheduled surgery (typically one day before oocyte retrieval). Overall, 50 men (50/727, 6.9%) used these rare, ejaculated sperm for ICSI. Semen samples obtained with <24 hours of abstinence were more likely to have better motility than the sample initially provided on the day of the planned mTESE. The live birth rate per ICSI attempt using these rare, ejaculated sperm was 36% (19/53). CONCLUSION: Providing a fresh ejaculated semen sample on the day of mTESE allows nearly 10% of men with azoospermia to avoid surgery with satisfactory ICSI outcomes. Providing multiple ejaculated samples over a short period of time does not adversely affect sperm concentration and may enhance sperm motility in men with cryptozoospermia.