Haim Yaffe

Electroejaculation before chemotherapy in adolescents and young men with cancer

OBJECTIVE To evaluate the outcome of repeated electroejaculation for obtaining semen from adolescents and young men before initiation of anticancer therapies. DESIGN Retrospective clinical study. SETTING Bikur Cholim Hospital, Jerusalem, Israel. PATIENT(S) Six young male patients (average age, 18+/-3 years) with diagnosed cancer who underwent 12 procedures of electroejaculation before chemotherapy. INTERVENTION(S) Transrectal electroejaculation. Semen was cryopreserved in small aliquots. MAIN OUTCOME MEASURE(S) Semen analysis. RESULT(S) In all patients, semen was obtained by electroejaculation. Sperm count and motility were relatively low; mean values were 16 x 10(6) (range, 0--45 x 10(6)) and 14% (range, 0--53%) respectively. CONCLUSION(S) If necessary, electroejaculation can be performed in adolescents, and sperm may be obtained by repeated treatments over a short period.

Pregnancy rates after communal growth of preimplantation human embryos in vitro

OBJECTIVE To evaluate the effect of communal growth of preimplantation human embryos on pregnancy rates in IVF-ET. DESIGN Prospective randomized study. SETTING In Vitro Fertilization Unit, Bikur Cholim Hospital, Jerusalem, Israel. PATIENTS Ninety-one women undergoing 91 cycles of IVF-ET. INTERVENTION In 42 cycles (control) embryos were grown singly, in 49 cycles (study) embryos were grown in groups until transfer. MAIN OUTCOME MEASURES Proportion of women achieving pregnancy in study and control groups. RESULTS Communal growth of embryos resulted in significantly improved pregnancy rates. Intrauterine transfer of embryos grown in groups produced 43% pregnancy rates per transfer, whereas, with embryos grown individually, 24% pregnancy rates were obtained (odds ratio = 2.4). CONCLUSIONS Our study suggests that, in IVF, the potential of preimplantation human embryos to produce pregnancy tends to increase when embryos are grown in groups.

Electroejaculation and assisted fertility in men with psychogenic anejaculation

OBJECTIVES To evaluate sperm characteristics and fertility potential in ejaculates obtained after electroejaculation in men with psychogenic anejaculation. DESIGN Retrospective clinical study. SETTING In Vitro Fertilization Unit, Bikur Cholim Hospital, Jerusalem, Israel. PATIENTS Twenty men with psychogenic anejaculation who underwent 55 sessions of electroejaculation and their spouses. INTERVENTIONS Electroejaculation, assisted reproduction technologies. MAIN OUTCOME MEASURES Semen analysis, IVF, intracytoplasmic injection (ICSI), fertilization rates, and pregnancy rates. RESULTS In all patients, sperm density and motility rates were unsatisfactory (98 +/- 127 x 10(6) with 14.6% +/- 15% motility in the antegrade portions and 42 +/- 42 x 10(6) with 9.7% +/- 15.6% motility in the retrograde samples). Intrauterine inseminations performed in eight couples did not result in a pregnancy. Four couples underwent IVF-ET treatments. Two pregnancies were achieved with overall success rates of 22% per cycle. Five couples were treated using the ICSI procedure. Although good quality embryos were transferred, none of the treatments resulted in a pregnancy. CONCLUSIONS Psychogenic failure to ejaculate may be treated by electroejaculation. However, the average motility of the sperm obtained is diminished. The combination of electroejaculation with IVF, including the ICSI procedure, should improve chances of fertilization and pregnancy in these cases.

Nocturnal sperm emission in men with psychogenic anejaculation

OBJECTIVE To evaluate sperm characteristics and fertilization potential in sperm obtained from nocturnal emission in men with psychogenic anejaculation. DESIGN Retrospective study. SETTING In Vitro Fertilization Unit, Bikur Cholim Hospital, Jerusalem, Israel. PATIENT(S) Six men with psychogenic anejaculation. INTERVENTION(S) Nocturnal emission, electroejaculation, sperm cryopreservation, and assisted reproduction technologies. MAIN OUTCOME MEASURE(S) Semen analysis, intracytoplasmic sperm injection (ICSI), fertilization rates. RESULT(S) In four patients, the concentration and motility of sperm obtained from freeze-thawed nocturnal emission were decreased compared with sperm from electroejaculation. Fertilization rates after ICSI using the nocturnal emission sperm were relatively low (45%). One clinical pregnancy was achieved after intrauterine insemination. CONCLUSION(S) The quality of sperm from nocturnal emissions is variable, but it can be used in assisted reproduction procedures to avoid aggressive procedures such as electroejaculation or testis biopsy.

The effect of disopyramide on uterine contractions during pregnancy

To evaluate the effect of disopyramide on uterine contractions during pregnancy, the drug was given for 48 hours to 10 women with indications for labor induction. Placebo was given to 10 other women with the same indications for induction. During the study period, regular uterine contractions occurred in 10 women in the study group, as compared with none in the control group (p less than 0.0001). Eight women in the study group were delivered of infants within 48 hours, as compared with none in the control group (p less than 0.0001). The mean time until the appearance of regular uterine contractions in the study group (4.15 +/- 1.76 hours) was significantly shorter (p less than 0.001) than that in the control group (56.13 +/- 5.28 hours). Patients who were not delivered of infants within 48 hours received other medications (prostaglandin E2, oxytocin). The mean maternal blood level of disopyramide at the time of appearance of uterine contractions was 1.52 +/- 0.9 mg/ml. The mean maternal level at delivery was 0.93 +/- 0.43 mg/ml and the cord blood level at the time of delivery was 0.33 mg/ml (cord blood/maternal level ratio = 0.36, r = 0.73, p less than 0.05). These results indicate that disopyramide should not be used in pregnancy for antiarrhythmic purposes because it may induce uterine contractions and delivery.

Simultaneous swim-up/swim-down of sperm in assisted reproduction procedures

PurposeHigh-quality motile human spermatozoa were obtained following treatment of semen by simultaneous swim-up into medium and swim-down into an isotonic 40% Percoll solution.ResultsThis procedure was significantly better than the swim-up method and comparable to discontinuous Percoll gradient centrifugation. Recovery rates of motile sperm were 35% for swim-up, 65% for Percoll gradient centrifugation, and 73% for swim-up/swim-down.ConclusionThe swim-down sperm was inferior to the swim-up sperm in its upward migration capacity but superior in morphology. Spermatozoa obtained by the swim-up/swim-down procedure demonstrated fertilizing ability in IVF, and clinical pregnancies were established. The simultaneous swim-up/swim-down procedure offers an alternative efficient method of simple separation of high-quality motile sperm for various assisted reproduction techniques.

A prospective study of the active management of labor in women of high parity

High parity has been suggested as contra-indication for the use of oxytocin stimulation in labor. The aim of our study was to prospectively evaluate a protocol of oxytocin administration in 130 consecutive low-risk patients having their sixth or subsequent delivery. Induction of labor failed only in 5 cases. No adverse effect on maternal and perinatal outcome was found. We conclude that with the introduction of electronic fetal monitoring and direct recording of uterine activity, oxytocin can be safely used for low-risk grand multiparae.

Decreased levels of fibrinogen in very high parity women

OBJECTIVES To evaluate coagulation parameters in healthy pregnant grand grand multiparous women. STUDY DESIGN Prothrombin time (PT), activated partial thromboplastin time (PTT), fibrinogen, D-dimer, albumin and blood lipids were prospectively determined in 50 pregnant grand grand multiparas (> or =9 deliveries) and 50 age-matched pregnant women with low parity (< or =3 deliveries). RESULTS The average concentrations of fibrinogen in the grand grand multiparas were 4.0+/-0.6 as compared to 4.7+/-0.7 g/l in the control group (P<0.001). In both groups D-dimer levels were >1000 ng/ml and the concentrations of albumin, triglycerides, cholesterol, high-density lipoprotein (HDL) were not significantly different. CONCLUSIONS In healthy pregnant grand grand multiparous women fibrinogen levels are lower than in age-matched women with low parity. These changes are not directly associated with lipids metabolism during pregnancy.

Sinusoidal Heart Rate Pattern And An Normal Biophysical Profile In A Severely Compromised Fetus

A case is described in which a woman complained of weakened fetal movements, and a persistent sinusoidal heart rate pattern was demonstrated in the presence of normal fetal breathing movements, normal fetal tone, and normal amount of amniotic fluid. In view of the subjective complaints and disregarding the normal biophysical profile, termination of pregnancy was performed. A compromised, severely anemic fetus was delivered by cesarean section. The role of sinusoidal heart rate pattern and the limitations of biophysical scores as a single determinant of fetal well being are discussed.