James C. Mayer

Assisted fertility using electroejaculation in men with spinal cord injury―a review of literature

OBJECTIVE To review the effectiveness of rectal probe electroejaculation in terms of pregnancy in treatment of anejaculatory males due to spinal cord injury. The characteristics of electroejaculates also are examined. DATA IDENTIFICATION All English language studies reporting pregnancies as a result of electroejaculation from men with spinal cord injury and related publications on electroejaculation were identified through MEDLINE search and manual scanning of recent relevant journals. RESULTS Electroejaculation has become an accepted mode of semen procurement in anejaculatory individuals, with a success rate of approximately 60% to 90% varying among different centers. In general these electroejaculates exhibit high sperm counts but low motility and poor sperm function. Retrograde ejaculation is also common. Pregnancies using electroejaculates have been documented since 1975 in the form of case reports and small series. Assisted reproductive technology recently has been used in conjunction with electroejaculation. Although results are encouraging, pregnancy rates, however, cannot be accurately estimated because of the lack of large series in the literature. CONCLUSIONS An increasing number of spinal cord-injured patients desiring fertility can achieve pregnancy through combined use of electroejaculation and assisted reproductive techniques. Larger series are needed to establish an accurate pregnancy rate. Elucidation by further studies on etiology of sperm dysfunction of these individuals may improve their prognosis.

A prospective series of unruptured ectopic pregnancies treated by tubal injection with hyperosmolar glucose

Objective To evlauate the safety and efficacy of hyperosmolar glucose injection in select unruptured tubal gestations with hCG levels less than 2500 mIU/mL. Methods In this prospective series, 16 patients with an hCG titer less than 2500 mIU/mL and an unruptured ectopic pregnancy were treated by tubal injection with hyperosmolar (50%) glucose. Hyperosmolar glucose was injucted transabdominally into the antimesenteric site of the tubal pregnancy, using a 20-gauge spinal needle. The main outcome measures evaluated were duration of surgery, success rate, time to resolution, and follow-up tubal patency rates. Results Ninety-four percent (15) of the subjects were treated successfully with a median time to resolution of 24 days (range 5–78). The one treatment failure required methootrexate because of rising hCG titers and worsening pain 4 days after the patient was treated with hperosmolar glucose. The mean (± standard error) duration of surgery was 45 ± 6 minutes. So far, all ten patients undergoing postoperative hysterosalpingograms have demonstrated tubal patency in the treated tube. Conclusion Laparoscopic injection with hyperosmolar glucose is an effective, systemically nontoxic alternative treatment for select unruptured ectopic pregnancies (hCG less than 2500 mIU/mL) that achieves tubal patency rates comparable to other conservative medical and surgical thretments.

Ultrasound-guided injection of ectopic pregnancy.

Preliminary studies have demonstrated that salpingocentesis is a safe and effective treatment for unruptured ectopic pregnancies that are visible by transvaginal ultrasound. So far, experience with this technique has been confined to only a few centers around the world. The most promising results of these studies has been the virtual absence of side effects associated with local injection of either methotrexate or hyperosmolar glucose. Large prospective trials comparing efficacy, safety, and overall cost of salpingocentesis against systemic methotrexate will be necessary to better define the role of salpingocentesis in the management of ectopic pregnancy. Patient recruitment for this type of clinical trial would be feasible and acceptable to patients because both treatment arms would avoid surgery.

Embryo Transfer Catheter Contamination With Intravaginal Progesterone Preparations in a Simulated Embryo Transfer Model Impairs Mouse Embryo Development Are There Implications for Human Embryo Transfer Technique

Objectives: To study the effect of embryo transfer (ET) catheter contact with intravaginal progesterone preparations on mouse embryo development. Study Design: In a simulated ET model, ET catheters were loaded with culture medium, placed in contact with intravaginal progesterone gel (Crinone 8%) or micronized progesterone intravaginal inserts (Endometrin 100 mg), and the intracatheter culture medium flushed. Embryos were cultured in the flushed culture medium at variable dilutions for variable lengths of time. Proportion of embryos progressing to blastocyst, embryo cell number, and apoptotic index was analyzed. Results: None of the embryos cultured in undiluted progesterone-exposed medium progressed to blastocyst. The likelihood of achieving blastocyst status and the average embryo cell number increased significantly as culture media exposed to intravaginal progesterone was diluted. A significant decrease in cell number became apparent between 1 and 2 hours of exposure. Interestingly, the apoptotic index was significantly higher in progesterone-exposed embryos as compared to unexposed embryos. Conclusion: The contamination of ET catheter with intravaginal progesterone significantly impairs mouse embryo development, likely due in part to increased programmed cell death.