Carol A Holden

Semen storage for special purposes at Monash IVF from 1977 to 1997

OBJECTIVE To review 20 years of experience with sperm storage before vasectomy or before chemotherapy and/or radiation therapy (medical storage), and to evaluate its usefulness. DESIGN Retrospective data analysis. SETTING University-affiliated reproductive medicine clinic. PATIENT(S) Two hundred fifty-six men who underwent vasectomy and 258 men who underwent chemotherapy and/or radiation therapy. INTERVENTION(S) Review of patient clinical notes. MAIN OUTCOME MEASURE(S) The subsequent use of cryostored sperm and the number of pregnancies that resulted. RESULT(S) Only 4 of the 256 men who underwent vasectomy returned for treatment, and three pregnancies were achieved. Eighteen of the 258 men who underwent chemotherapy and/or radiation therapy returned for treatment, and six pregnancies were achieved. CONCLUSION(S) Only a small proportion of men (2%) returned to use their cryostored specimens after vasectomy, and pregnancy was achieved in most cases. Seven percent of men returned to use their specimens after chemotherapy and/or radiation therapy, and pregnancy was achieved in only one third of cases.

Semen analysis: its place in modern reproductive medical practice

&NA; Semen analysis is the most important laboratory investigation for men when assessing the infertile couple. Advances in in vitro fertilisation (IVF) techniques, particularly intracytoplasmic sperm injection (ICSI) involving the direct injection of a single spermatozoon into an egg, have not diminished the role of semen analysis in modern reproductive practice. Semen analysis is the most basic laboratory investigation undertaken and is descriptive in terms of semen volume, appearance, viscosity, sperm concentration, sperm motility and morphology. Since the results are used by clinicians to choose appropriate treatment options, a reliable service is imperative. It is crucial that the laboratory is experienced in the performance of semen analyses to ensure an accurate result. To ensure a quality semen analysis service, laboratories must participate in internal and external quality assurance activities, incorporate rigorous training protocols for technical staff and use reliable procedures. The World Health Organization laboratory manual for the examination of human semen and sperm cervical mucous interaction, clearly describes the variables that need to be assessed and the methods of analysis and quality assurance to be used.

The correlates of chronic disease-related health literacy and its components among men: a systematic review

BackgroundChronic diseases drive the burden of disease in many societies, particularly among men. Lifestyle behaviours are strongly associated with chronic disease development, and in a number of countries men tend to engage in more risky behaviours, and have lower health knowledge and attention to prevention, than women. This study investigated the correlates of men’s health literacy and its components about major lifestyle-related diseases, namely ischaemic heart disease and type 2 diabetes mellitus, to gain evidence to guide the development of policy and programs to improve men’s health.MethodsA systematic review was undertaken of observational studies that investigated men’s health literacy and its components related to ischaemic heart disease or type 2 diabetes mellitus, and their associated risk factors. The Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycINFO, Embase and the Cochrane Library databases were searched for articles published since 2003. The strength of the evidence was rated using the GRADE approach.ResultsAfter screening and review of 504 articles, the search elicited nine studies for inclusion: only one study examined health literacy (nutrition literacy). The majority of included studies focused on only one component of health literacy, namely knowledge (n = 7) and personal skills (confidence) (n = 1). Twenty correlates were identified, primarily relating to the knowledge component, with the strength of the evidence for only one correlate, education, graded as being of moderate quality. The evidence for all other correlates was graded as being of low quality.ConclusionsThe limited body of research identified may have resulted from a lack of consensus about the definition of health literacy, and a concordant set of validated health literacy measures. Despite these limitations, broadening the search to include components of health literacy has identified that several factors are associated with men’s knowledge and awareness of ischaemic heart disease and type 2 diabetes mellitus that will assist in the development of men’s health promotion strategies. However, addressing the broader knowledge gaps and controversy in the health literacy field will deliver policy and program benefits to address these major contributors to the burden of disease among men.

Healthy aging in a cross-sectional study of Australian men: what has sex got to do with it?

Abstract Aim: To identify lifestyle factors associated with healthy aging in middle-aged and older Australian men. Methods: A cross-sectional, population-based, computer-assisted telephone interview study explored self-reported health outcomes, and associated determinants for general and reproductive health (the Men in Australia Telephone Survey) in men aged 40 years and older (n = 5990). “Good health” was defined by self-reported health (excellent/very good) combined with absence of self-reported high blood pressure, heart disease, stroke, diabetes and depression symptoms. Categories of sexual activity frequency in the previous four weeks ranged from zero to 12+ times. Results: “Good health” declined with increasing age with 17% of men over 70 years reporting “good health”. In multivariable logistic regression models, significant inverse associations were found between modifiable lifestyle factors – both underweight and overweight/obesity, physical inactivity, smoking and high alcohol consumption – and “good health”. Low-risk alcohol intake and living with a partner were positively associated with “good health”. Sexual activity was also positively associated with “good health” (p < 0.001) with elevated odds ratios (ORs) for each category of frequency of sexual activity (1–4, 5–8, 9–12 or 12+ times in the past 4 weeks) relative to zero frequency (ORs 1.68 to 2.16). Conclusion: This study suggests that sexual activity is an important correlate of retaining good health in middle- and older-aged men, independent of other behavioral determinants.

Male reproductive health disorders among Aboriginal and Torres Strait Islander men: a hidden problem?

Objective: To better understand help‐seeking behaviours and reproductive health disorders among Aboriginal and Torres Strait Islander men.

Clinical results from intracytoplasmic sperm injection at monash IVF

The impact of a modification of the intracytoplasmic sperm injection (ICSI) technique on fertilization and pregnancy rates was examined in a retrospective analysis of 171 consecutive ICSI treatment cycles (156 patients). Patients were selected for ICSI on the basis of severe oligoasthenozoospermia (65 patients) or following conventional in vitro fertilization (IVF) with failed or poor fertilization (70 patients). Seven patients in which epididymal or testicular sperm was used, 10 patients with sperm antibodies and 4 patients with retrograde ejaculation or who required electro-ejaculation were also treated with ICSI. In the first 105 cycles (102 patients), single sperm, rendered immotile, were injected into the ooplasm of 979 metaphase II (M II) oocytes using an established technique (Method 1). In the following 66 cycles (513 M II oocytes injected), the ICSI procedure was modified by increased aspiration of the oolemma to ensure the intracytoplasmic deposition of sperm (Method 2). The patient groups did not differ between the two injection procedures. The normal (two pronuclear) fertilization rate increased significantly (P < 0.001) from 34.3% with Method 1 to 73.1% with Method 2, with no difference in the oocyte degeneration rate (4.3% v. 4.5% respectively). The incidence of failed fertilization was significantly (P < 0.01) reduced from 17.1% (18 cycles) to 1.6% (1 cycle) with the change in technique. As a consequence of the increased fertilization rates with Method 2, more embryos were available for assessment and transfer, and a pregnancy rate per oocyte retrieval of 21.2% was obtained for Method 2. Fertilization, embryo transfer and pregnancies were obtained in all patient groups treated with ICSI.(ABSTRACT TRUNCATED AT 250 WORDS)

“Men’s health – a little in the shadow”: a formative evaluation of medical curriculum enhancement with men’s health teaching and learning

BackgroundEnhancing a medical school curriculum with new men’s health teaching and learning requires an understanding of the local capacity and the facilitators and barriers to implementing new content, and an approach that accommodates the systemic and cultural differences between medical schools.MethodsA formative evaluation was undertaken to determine the perspectives of key informants (academics, curriculum developers) from four Australian medical schools about the strategies needed to enhance their curriculum with men’s health teaching and learning. Through semi-structured questioning with 17 key informants, interviewees also described the contextual barriers and facilitators to incorporating new topic areas into existing curriculum. Interviews were recorded with consent, transcribed verbatim, and analysed by two researchers to identify key themes.ResultsInterviewees were enthusiastic about incorporating men’s health content through a men’s health curriculum framework but highlighted the need for systems to assist in identifying gaps in their current curriculum where the men’s health topics could be integrated. The student experience was identified as a key driver for men’s health teaching and learning. Furthermore, core men’s health clinical outcomes needed to be defined and topic areas vertically integrated across the curricula. This would ensure that students were appropriately equipped with the skills and knowledge for subsequent clinical practice in a range of geographical settings. Interviewees consistently suggested that the best implementation strategy is to have someone ‘on the ground’ to work directly with medical school staff and champion the men’s health discipline. Providing mechanisms for sharing knowledge and resources across medical schools was highlighted to facilitate implementation, particularly for those medical schools with limited men’s health teaching resources.ConclusionsDespite the unanimous support for men’s health teaching and learning, the evaluation highlighted that the student experience must be recognised as paramount when integrating new topic areas into an already packed curriculum. A community of practice, where medical schools share relevant resources and knowledge, could help to ensure a commonality of student experience with respect to men’s health learning in medical schools across different geographical settings and with different levels of resourcing. Such an approach could also be adapted to other areas of curriculum enhancement.

Coaching to support men in making informed choices about prostate cancer screening: A qualitative study

OBJECTIVE The objective of this study was to examine the perceptions of men, practice nurses (PNs) and general practitioners (GPs) on patient decision coaching for prostate cancer screening. METHODS Seven focus groups were conducted with 47 participants, representing three stakeholder groups - men, GPs and PNs. All focus group discussions were conducted by the same facilitator and guided by a semi-structured interview schedule. Transcriptions were analysed by thematic analysis. RESULTS Knowledge about the merits of prostate cancer screening was high amongst GPs, but limited with PNs and men. All groups saw the value in PN-led decision coaching for men considering screening for prostate cancer, but had reservations about its implementation in practice. Barriers to implementing a decision coaching system with PNs included staffing and cost of implementation. CONCLUSION GPs, PNs and men identified benefits for the use of a PN-led decision coaching support intervention to assist men with making an informed choice about screening for prostate cancer. Stakeholders had reservations about how a PN-led intervention would effectively work in clinical practice. PRACTICE IMPLICATIONS A feasibility study is required to examine barriers and enablers to implementing a PN-led decision coaching process for prostate cancer screening in the Australian primary healthcare setting.

Are nurses meeting the needs of men in primary care

Meeting mens health needs by improving healthcare service access is a key objective of comprehensive primary health care. The aims of this qualitative study were to explore the perception of nurses in mens health services and to describe mens expectation of the nurse. The comparative component identifies the barriers and facilitators to improved access to health services. A purposive sample of 19 nurses and 20 men was recruited from metropolitan and regional settings in the state of Victoria, Australia, and each participant was interviewed individually or as part of three focus groups. The main findings were: nurses and men were unclear on the role of the nurse in mens health; and health promotion provided by nurses was predominantly opportunistic. Both participant groups indicated barriers to healthcare access related to: the culture and environment in general practice; limitation of Australias Medicare healthcare financing system; out-of-pocket costs, waiting time and lack of extended hours; and men not wanting to be perceived as complainers. Facilitators related to: positive inter-professional relations; effective communication; personal qualities; and level of preparedness of nurse education. The findings demonstrate a need for the role to be better understood by both men and nurses in order to develop alternative approaches to meeting mens healthcare needs.