Cappy Miles Rothman

Results in the United States with Sperm Micro-Aspiration Retrieval Techniques and Assisted Reproductive Technologies

AbstractImproved methods of urological microsurgery and of various assisted reproductive technologies have resulted in the ability to achieve pregnancies with sperm aspirated microsurgically from men with bilateral congenital absence of the vasa deferentia or with ductal obstructions that cannot be surgically reconstructed. A survey was conducted of the results of such procedures performed in the United States during approximately 2 years. Female partner ovarian stimulation was initiated in 219 instances at 22 centers. Of the 219 procedures 23 (11%) were terminated without attempting any form of gamete fertilization or insemination of the wife for various reasons (no sperm or too few sperm retrieved, poor to absent sperm motility or poor quality eggs). The etiology of azoospermia in the 219 procedures was congenital absence of the vasa deferentia in 115 cases (52%), other congenital conditions in 15 (7%), failed vasectomy reversal in 37 (17%), infection in 4 (2%), other conditions (mainly ejaculatory dysf...

The recurrent varicocele—a poorly recognized problem

A varicocele is most likely the result of an incompetent vein with retrograde flow of blood into the scrotum. Surgical ligation of this incompetent system is the present-day procedure of choice. In our series of 225 varicocelectomies, there have been three definite recurrences, due to either recollateralization or failure to ligate all branches of this venous plexus.

The effect of ultrasound coupling gels on sperm motility in vitro

Several of the most commonly used ultrasound coupling gels were found to adversely affect sperm motility. These gels should not be used in patients undergoing insemination immediately after a transvaginal pelvic ultrasonographic examination. Instead, we recommend the use of Proception Sperm Nutrient Douche, Nutrient Mixture F-10 (HAM), or nonlubrication of the condom-covered transducer.

Micromanipulation in a center for reproductive medicine

Several variations of micromanipulation of the female gamete (zona drilling, zona cracking, ooplasmic sperm injection, partial zona dissection) have been applied recently to human IVF to overcome severe male factor. Of the first 16 cycles attempted using partial zona dissection, one pregnancy resulted leading to a normal term delivery. Careful removal of the coronal cells, as well as stepwise removal of sucrose postpartial zona dissection, will facilitate this procedure and greatly reduce potential damage to the oocyte by pH, mechanical, or thermal injury. Micromanipulation has become a routine service offered in our program in cases where the likelihood of a poor IVF outcome is either known or suspected, and also serves as a replacement for simple reinsemination in cases of failed fertilization.

Clinical Aspects of Sperm Bank

The ability to preserve human sperm by cryogenic methods has been developed and successfully applied to reproductive biology. Some of the advantages include 1) availability of sperm for heterologous (donor) insemination, 2) accumulation of multiple oligospermic specimens for homologous (husband) insemination, 3) preservation of sperm prior to vasectomy, 4) collection and preservation of sperm from men who face permanent injury to spermatogenesis through an operation, chemotherapy or radiation, 5) to obviate the potential genetic danger of mans exposure to environmental pollutants such as radiation and 6) availability of husbands sperm at ovulation time.

Case Report: Varicocele or Cirsocele

A man with a left varicocele and the physical finding of deep and superficial scrotal varicosities is described. The recurrence of these veins after high retroperitoneal ligation was the first indication of recollateralization. A review of the early literature reveals that varicocele refers to the varices of the scrotum and cirsocele (earlier term to denote the physical finding of scrotal varicosities) applies to the varices of the testicle and cord. It appears that these may be the same.

Development and validation of CryoCocoons™ for the safe, aseptic storage of sperm cryovials

Most sperm banks in the United States continue to process and freeze samples in “open” cryovial devices. Yet, due to growing European attention to the long-term cryostorage of gametes and embryos in an aseptic manner, we evaluated the possibility of repackaging cryovials into a sealed (i.e. closed) “CryoCocoon™”container, when distributing donor sperm vials to countries with aseptic container cryostorage restrictions. We conducted a series of controlled, prospective experiments to validate the efficacy of the CryoCocoon™ concept. Cryovials were securely repackaged within 45 s under ambient conditions while maintaining sub −100°C temperatures, before refreezing, without adversely influencing post-thaw motility. However, unique challenges in terms of container buoyancy, cryocane storage and labeling condensation had to be overcome. Although not particularly ideal to the long-term storage of pathogen-free donor sperm vials, CryoCocoons™ constitute a novel approach to the creation of an aseptic storage contai...