Fertility in men with spinal cord injury.

Young men comprise the overwhelming majority of men with spinal cord injury (SCI), the incidence of which has been growing over the years. Due to advances in physical medicine and rehabilitation, remarkable improvements in survival rates have been reported, leading to life expectancies similar to those of the general population. However, many sexual and reproductive functions may be impaired due to erectile or ejaculatory dysfunction and semen abnormalities, characterised by low-sperm motility or viability in SCI males who have not become parents yet. Nevertheless, fatherhood is still possible through the introduction of specialised medical management, by using various medical, technical and surgical methods for sperm retrieval in combination with assisted reproductive techniques. Erectile dysfunction can be managed by the use of phosphodiesterase-5 inhibitors, intracavernosal injections, vacuum devices and penile prostheses. Semen can be obtained from the vast majority of anejaculatory men by medically assisted ejaculation through the use of penile vibratory stimulation or electroejaculation and via prostate massage or surgical procedures. Despite impaired sperm parameters, reasonable pregnancy rates similar to those in able-bodied subfertile cohorts have been reported. However, future research should focus on the optimisation of semen quality in these men and on improving natural ejaculation.

Sperm cryopreservation before testicular cancer treatment and its subsequent utilization for the treatment of infertility.

AIMS: In this study we report our results with storage of cryopreserved semen intended for preservation and subsequent infertility treatment in men with testicular cancer during the last 18 years. METHODS: Cryopreserved semen of 523 men with testicular cancer was collected between October 1995 and the end of December 2012. Semen of 34 men (6.5%) was used for fertilization of their partners. They underwent 57 treatment cycles with cryopreserved, fresh, and/or donor sperm. RESULTS: A total of 557 men have decided to freeze their semen before cancer treatment. Azoospermia was diagnosed in 34 men (6.1%), and semen was cryopreserved in 532 patients. Seminoma was diagnosed in 283 men (54.1%) and nonseminomatous germ cell tumors in 240 men (45.9%). 34 patients who returned for infertility treatment underwent 46 treatment cycles with cryopreserved sperm. Totally 16 pregnancies were achieved, that is, 34.8% pregnancy rate. CONCLUSION: The testicular cancer survivors have a good chance of fathering a child by using sperm cryopreserved prior to the oncology treatment, even when it contains only limited number of spermatozoa.

The reproductive outcome of an infertile man with AZFc microdeletions, via intracytoplasmic sperm injection in a high-risk pregnancy: Case report and literature review.

RATIONALE: Infertile men with Y-chromosome microdeletions have been reported to be able to have their own children via intracytoplasmic sperm injection (ICSI). PATIENT CONCERNS: A 27-year-old man with Y-chromosome azoospermia factor c (AZFc) deletions underwent ICSI treatment. The pregnancy showed a high risk for trisomy 21 syndrome (risk value: 1 in 150). DIAGNOSES: The karyotype of the patient was 46, XY, inv (9) (p11q13). His wife had a normal karyotype. Sequence-tagged site-based polymerase chain reaction (PCR) analysis showed that markers sY254 and sY255 were absent. ICSI was performed. Two embryos (6IV, 8II) were transferred to the uterus of the patient's wife. Second-trimester maternal serum triple-screening showed that the pregnancy was high risk for trisomy 21 syndrome (risk value: 1 in 150). Amniocentesis was performed and revealed that the fetal chromosomal karyotype was 46, XX, inv (9) (p11q13). INTERVENTIONS: The couple chose to continue the pregnancy and a healthy girl was born at 39 weeks of gestation. OUTCOMES: An infertile man with AZFc microdeletions can reproduce via ICSI technology. The karyotype inv (9) (p11q13) can be transmitted to offspring. Whether this karyotype has clinical significance, such as causing infertility or variations in prenatal biochemical markers, is unclear. LESSONS: Y-chromosome microdeletions and/or the karyotype inv (9) (p11q13) may cause clinically significant variation in prenatal biochemical markers.

[Classification of male infertility].

The article presents a new classification of male infertility which takes into consideration new data on aspermia, aspermatism and pathospermia. This brief classification is convenient for every day practice of physicians engaged in rehabilitation of patients with urological and andrological diseases.

Comparing the Effectiveness of Dietary Vitamin C and Exercise Interventions on Fertility Parameters in Normal Obese Men.

PURPOSE: Comparing the effectiveness of dietary vitamin C and weight loss exercises interventions for weight loss on semen characteristics in normal obese man. MATERIALS AND METHODS: A total number of 200 men were randomly allocated into two groups based on body mass index, exercise and vitamin C groups. Also, 50 men with normal spermogram were placed in a control group. In exercise group, a 6 months intensive exercise program was designed under a coach's supervision to reduce the body weight. In vitamin C group, 1,000 mg of vitamin C were given every other day as supplement. RESULTS: Weight loss increased the volume of semen in participants with 25-30 (P = .02) and more than 30 body mass index (P = .001). The increased concentration of sperm per mL of semen in body mass index (BMI) 25-30 group (P = .01) and more than 30 (P = .003) BMI was significant. Improving sperm motility after two hours in participants with more than 30 (P = .01) BMI was significant. In vitamin C group, the improvement of sperm concentration in participants who had less than 25 (P = .01), between 25 and 30 (P = .01), more than 30 (P = .02) BMI was significant. Sperm motility improved in all three groups (P = .001, P = .02 and P = .003, respectively). CONCLUSION: Weight loss can significantly increase semen volume, its concentration, its mobility and percentage of normal morphology. Consuming vitamin C significantly improves sperm concentration and mobility, but the semen volume and the percentage of normal morphology will not change significantly.

Knowledge and experience regarding cancer, infertility, and sperm banking in younger male survivors.

PURPOSE: The goal of this study was to survey male patients aged 14 to 40 years at diagnosis and recently treated in two cancer centers to determine their knowledge, attitudes, and experiences regarding cancer-related infertility and sperm banking. PATIENTS AND METHODS: A postal survey about cancer-related infertility and sperm banking was offered to 904 men diagnosed with cancer within the previous 2 years. Eight percent opted out of the study. The others were sent the survey, with a cover letter stating elements of informed consent. RESULTS: Although the return rate was only 27%, yielding a sample of 201 men, responders did not differ significantly from nonresponders by institution, age, ethnicity, or cancer site. Overall, 51% of men wanted children in the future, including 77% of men who were childless at cancer diagnosis. Despite some anxieties about their own survival and risks to their children's health, men felt that the experience of cancer increased the value they placed on family closeness and would make them better parents. Only 60% of men recalled being informed about infertility as a side effect of cancer treatment, and just 51% had been offered sperm banking. Those who discussed infertility with their physicians had higher knowledge about cancer-related infertility and were significantly more likely to bank sperm. Only 24% of men banked sperm, including 37% of childless men. Lack of information was the most common reason for failing to bank sperm (25%). CONCLUSION: All men who are about to receive cancer treatment that could impair fertility should be counseled about such side effects and given adequate information to make an informed decision about banking sperm.

The effect of penile vibratory stimulation on male fertility potential, spasticity and neurogenic detrusor overactivity in spinal cord lesioned individuals.

PURPOSE: Present the possibility for treatment of male infertility, spasticity, and neurogenic detrusor overactivity in spinal cord lesioned (SCL) individuals with penile vibratory stimulation (PVS). METHOD: Obtaining reflex-ejaculation by PVS, by using a vibrator developed for this purpose. The stimulation was performed with a vibrating disc of hard plastic placed against the frenulum of the penis (amplitude > or = 2.5 mm). The vibration continued until antegrade ejaculation or for a maximum of 3 minutes followed by a pause of 1 minute before the cycle was repeated, maximally 4 times. RESULTS: >80% SCL men are able to obtain ejaculation with PVS. Pregnancy rates obtained with home PVS and intra-vaginal insemination was 22-62% (4 studies), and with PVS or electroejaculation and intrauterine insemination/in-vitro fertilization/intracytoplasmatic sperm injection 39-64% (9 studies). PVS was demonstrated to decrease spasticity significantly when measured by the modified Ashworth scale. In addition, a decrease of the number of spontaneous EMG events which probably indicate spasms was observed. Increase in bladder capacity at leakpoint following 4 weeks of frequent ejaculation with PVS treatment was likewise demonstrated. CONCLUSION: PVS has proved its importance for SCL male fertility, in the years to come its place in treatment of spasticity and neurogenic detrusor overactivity has to be established.

IVF and ICSI in male infertility: update on outcomes, risks, and costs.

Assisted reproductive technology with intracytoplasmic sperm injection (ICSI) is becoming an international panacea for couples struggling with infertility. The increasing popularity of these techniques and the data generated has given us a better understanding of the efficacy, consequences and costs of these procedures. There still remain many unanswered questions and controversies surrounding the use of IVF and ICSI. Increased experience, better refinement of these techniques and clearer indications for IVF and ICSI will inevitably minimize the risks associated with this procedure.

[Excretory-inflammatory male infertility. Diagnostics, treatment and rehabilitation].

Up to 10 to 15% of couples are infertile; in 40 to 45% of cases this is caused by male infertility. The study compares the effects of conventional drug therapy (n = 95), magnetolaser therapy (n = 93), and magnetolaser puncture (MLP) (n = 94) on the generative function of 282 men with excretory-inflammatory form of infertility. The results show that the most effective in the complex treatment of chronic inflammatory diseases of the reproductive organs in infertile men is topical laser irradiation in magnetic field, applied to the sacrum and the perineum (91.2%), as well as MLP applied to the lumbar area (85.1%) vs. conventional drug therapy (64.2%). Topical application of low-intensive laser in magnetic field may be part of rehabilitation measures, taken in order to improve the fertilizing properties of the ejaculate. The treatment does not last long and consists of no more than 5 procedures. The therapy should be repeated not earlier than 6 to 9 months after the end of the first course.

Assisted reproductive outcomes of male cancer survivors.

PURPOSE: The objective of our study was to evaluate the reproductive outcome of male cancer survivors treated with intracytoplasmic sperm injection (ICSI) using cryopreserved sperm and compare it with the same treatment in non-cancer males. METHODS: We retrospectively analyzed database derived from cancer and non-cancer patients undergoing sperm cryopreservation from August 2008 to August 2012 at a university-based center. We evaluated the reproductive outcome of those cancer and non-cancer patients that had frozen sperm and returned subsequently to the clinic for assisted reproduction. RESULTS: We studied 272 males with cancer and 296 infertile males. The most prevalent types of cancer in our cohort were lymphoma (25.3 %), testicular cancer (19.2 %), leukemia (7.3 %), and other malignancies including sarcoma, gastrointestinal, and central nervous system malignancies (48.2 %). The use rate of cryopreserved sperm was 10.7 % for cancer patients and 30.7 % for non-cancer patients. The mean age of males with cancer who returned to the clinic for fertility treatment was 36.7 ± 6 years, and the diagnoses were testis cancer (43.4 %), lymphoma (36.9 %), leukemia (13 %), and other malignancies (6.7 %). Live birth rate of the cancer cohort was 62.1 %, which was higher than that of the normospermic non-cancer population (p < 0.0047). CONCLUSIONS: The use rate of cryopreserved sperm from oncofertility preservation cases is at around 10 %. The live birth rate using assisted reproductive technologies among these patients is at least comparable to that of the non-cancer population. IMPLICATIONS FOR CANCER SURVIVORS: To our knowledge, this was the first comparative study of male cancer survivors treated with ICSI using cryopreserved sperm, which were compared to non-cancer males undergoing the same treatment. Male fertility preservation is a highly valued service that should be strongly encouraged prior to beginning cytotoxic cancer treatment. These results can help healthcare professionals in oncology to improve the quality of counseling on fertility preservation when managing young men with newly diagnosed cancer that require gonadotoxic treatment.

An unusual complication during electroejaculation in an individual with tetraplegia.

Infertility in males is a common problem after spinal cord injury, often requiring interventional methods. In the authors' fertility program they have experienced 4 pregnancies and 3 live births using both electroejaculation (EEJ) and vibratory stimulation techniques. EEJ is a relatively safe procedure with few complications reported in the literature. Here is a case of a 23-year-old with C-6 ASIA A tetraplegia who, while receiving EEJ, developed autonomic dysreflexia that was followed by new onset atrial fibrillation. The patient's cardiac condition required management in the Emergency Department with pharmacologic conversion to a normal sinus rhythm. Although autonomic dysreflexia is a common adverse effect during EEJ, atrial fibrillation has not been previously reported as a complication. It is proposed that the patient's atrial fibrillation developed as a result of cardiac changes induced through autonomic dysreflexia.

[Extracorporeal fertilization and embryo transfer: a medico-ethical topic?]. / Extrakorporale Befruchtung und Embryotransfer: ein medizinisch-ethisches Thema?

In vitro fertilization and subsequent embryo transfer remains one of the most burning topical issues of medicine and medical ethics today. Like every individual ethical problem, extracorporeal fertilization initiated the question of the ethical and metaethical (anthropological) context of the origin of the problem and from which an answer may be forthcoming. The fact has to be taken into account that a uniform ethical culture is no longer possible on the grounds of the pluralism of creeds and world opinions. Ethically acceptable compromises have again and again to be looked for. However, the search for an ethical consensus of views runs the risk of being unable to keep pace with the dynamics of medical and technical progress.

Exploring male fertility options after spinal cord injury: the role of the nurse clinician.

Male sexual function and fertility are important areas that need to be addressed for men undergoing spinal cord injury (SCI) rehabilitation. Rehabilitation nurses need to understand what fertility after SCI involves. Significant advances in the areas of sperm retrieval and advanced reproductive technologies have made biological parenthood for many men with SCI a viable option. This article reviews the various sperm retrieval techniques and advanced reproductive technologies available today. It also describes the unique role of a nurse clinician working in a fertility clinic designed specifically to address the fertility concerns of men and their partners after SCI.

[Rehabilitation of patients with chronic prostatitis and reproductive dysfunction in a special hospital]. / Reabilitatsiia bol'nykh khronicheskim prostatitom s reproduktivnoi disfunktsiei v usloviiakh spetsializirovannogo statsionara.

Combined aftercare with mud applications, sinusoidal modulated currents (SMC) and UV radiation of autoblood was compared to conventional drug therapy in 56 and 30 patients, respectively, having chronic prostatitis with reproductive dysfunction. It was found that the combined aftercare raises the treatment efficiency due to a favourable effect on the immune system, inflammation in the prostate and spermatogenesis. It also promotes long-term remission.

Is ex vivo microdissection testicular sperm extraction indicated for infertile men undergoing radical orchiectomy for testicular cancer? Case report and literature review.

OBJECTIVE: To report a case of an infertile man with nonobstructive azoospermia who underwent simultaneous radical orchiectomy for testicular cancer and testicular sperm extraction (TESE) for preservation of fertility. DESIGN: Case report and literature review. SETTING: University teaching hospital. PATIENT(S): A couple being treated for infertility. INTERVENTION(S): Radical orchiectomy with simultaneous TESE. MAIN OUTCOME MEASURE(S): Sperm retrieval, histologic evaluation of archived testicular pathology slides. RESULT(S): We retrieved 20 spermatozoa from the multiple random TESE samples obtained at radical orchiectomy. Histologic evaluation of the archived testicular pathology slides revealed that the testis contained several foci of active spermatogenesis, suggesting that a significantly greater number of spermatozoa would likely have been retrieved had a microdissection TESE been performed instead of the multiple TESEs. CONCLUSION(S): We propose that microdissection TESE should be considered the preferred sperm retrieval technique at the time of radical orchiectomy in men with coexistent nonobstructive azoospermia and testicular cancer.

Other work has highlighted the limitations of using histopathology to predict success after varicocelectomy.

The morbidity associated with performing testicular biopsy on all men before varicocele repair appears to outweigh the benefit of any prognostic information obtained.

Finasteride-associated male infertility.

OBJECTIVE: To describe a male patient with finasteride-associated infertility. DESIGN: Case report. SETTING: Tertiary-care clinic for male infertility. PATIENT(S): A patient with azoospermia who had been taking finasteride (1-mg dose) for 1 year for androgenic alopecia. He had been diagnosed with oligospermia 5 years before. INTERVENTION(S): Discontinuation of finasteride. MAIN OUTCOME MEASURE(S): Improvement of semen parameters. RESULT(S): After cessation of finasteride, the patient's semen volume increased immediately, and sperm concentration was up to more than 10 × 10(6)/mL 16 weeks after stopping finasteride. He is now trying to achieve pregnancy by intrauterine insemination. CONCLUSION(S): Cessation of finasteride improved spermatogenesis and allowed the couple to attempt less-invasive fertility therapy. In this case, the patient had impaired spermatogenesis before he started the drug. In such patients, the drug may further decrease spermatogenesis. We suggest that drug cessation could be taken into consideration for infertile male patients with impaired semen parameters who are taking finasteride at a 1-mg dose.

The role of varicocele repair in nonobstructive azoospermia must be evaluated with controlled trials rather than observational studies.

Certainly, varicoceles can have a substantive effect on sperm production in infertile males. In addition, varicocele repair may optimize sperm production. However, additional studies and evaluation of the role of varicocele repair in men with this condition (nonobstructive azoospermia) are warranted.

Microsurgical and nonmagnified subinguinal varicocelectomy for infertile men: a comparative study.

OBJECTIVE: To compare semen parameters, pregnancy, recurrence, and complication rates after microsurgical and nonmagnified subinguinal varicocelectomy for infertile men. DESIGN: Prospective, randomized study. SETTING: Ghodran General Hospital, Kingdom of Saudi Arabia. PATIENT(S): One hundred sixty-two infertile male patients with varicocele. INTERVENTION(S): Eighty-two patients were treated by microsurgical subinguinal varicocelectomy (MSSIV) (group I), whereas 80 patients were treated by conventional, nonmagnified subinguinal varicocelectomy (NMSIV) (group II). MAIN OUTCOME MEASURE(S): The patients were postoperatively evaluated by physical examination and semen analysis after 4 and 12 months. Pregnancy rate was monitored during the follow-up period. RESULT(S): Postoperatively, mean sperm count and motility improved significantly in both groups: 42.7% and 67.1% of the MSSIV group and 23.7% and 33.8% of the NMSIV group showed ≥50% improvement in sperm count and motility after 1 year. Patients having bilateral varicocele showed significantly better improvement of sperm count than those with unilateral varicocele after both MSSIV and NMSIV. The pregnancy rate at the end of the follow-up period reached 37.8% in the MSSIV group and 21.2% in the NMSIV group. The recurrence rate was zero in the MSSIV group and 11.3% in the NMSIV group. The rate of hydrocele formation was 1.2% in the MSSIV group and 8.7% in the NMSIV group. CONCLUSION(S): Microsurgical subinguinal varicocelectomy has a better improving effect on sperm count and motility, higher spontaneous pregnancy rates, and lower postoperative recurrence and hydrocele formation than conventional subinguinal varicocelectomy in infertile men.