Yedidya Hovav

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.

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.

Diagnostic Laparoscopy in Primary and Secondary Infertility

Purpose:Our purpose was to compare the diagnostic efficacy of laparoscopy between primary and secondary infertility and to define a subgroup in which the positive findings are low.Methods:A retrospective review of the cases of 206 infertile women who underwent laparoscopy was conducted.Results:Eighty-two (39.8%) patients were found to have evidence of pelvic disease—20 (22.2%) with primary infertility and 62 (54.3%) with secondary infertility. The ratio of positive findings in secondary infertility was significant in comparison with the positive findings in primary infertility. In only 3 of the 20 patients with primary infertility was there no history of an abdominal operation, pelvic inflammatory disease, or an abnormal hysterosalphingography. Of the 62 women who suffered secondary infertility and had positive findings in laparoscopy, 15 had no history of suspect findings.Conclusions:The diagnostic yield of laparoscopy for primary infertility in the absence of indications of mechanical factors is low. Therefore the need for diagnostic laparoscopy in these cases should be reconsidered.

Antisperm Antibodies in Men with Psychogenic Anejaculation

Antisperm autoantibodies were determined in 16 men suffering from psychogenic anejaculation who underwent assisted reproduction treatments. Blood and semen samples were collected after transrectal electroejaculation and antisperm antibodies in serum and on the surface of motile spermatozoa were measured using the direct and indirect immunobead binding test. Five men (31%) were found positive for antisperm antibodies. The majority of antibodies were directed against the sperm heads. Surface antibodies were mainly IgA isotype whereas serum antibodies were IgG isotype. These results suggest that psychogenic anejaculation might be associated with increased incidence of antisperm autoimmunity.

Response to Marik

To the Editor: I read Dr. Marik’s letter with interest. There is no debate on the issue of the efficancy of laparoscopy in the investigation of infertility in women, although the question when to perform it is controversial. The difference in the percentages of pathological findings can be explained not only by the different stages at which the procedure is performed, but also by the population on which it is performed. In our population, the percentage of sexually transmitted diseases and endometriosis is quite low. We suggest that centers tailor their laparoscopy rate to the specific populations they serve. Population at high risk for tubal disease should likely have a higher rate of diagnostic laparoscopies performed. Similarly, populations at low risk for tubal disease may not require a high rate of diagnostic laparoscopies. Along with the many advantages of diagnostic laparoscopy as Dr. Marik described, there are a few complications associated with this procedure. These include injury to abdominal organs and to major blood vessels and complications due to the anesthesia (1–3). It can be assumed that these complications occur more often than are reported. One must remember that laparoscopy can reveal the anatomical state of the fallopian tubes but cannot give any information on their functional state (i.e., there may be a problem getting the ovum to or through the tubes). On the other hand, it is a known fact that there have been spontaneous pregnancies in women who have been diagnosed, using laparoscopy, as suffering from bilateral adhesions. Today, with the option of in vitro fertilization (IVF), it is often hard to persuade a woman with a normal human serum gonadotropin to undergo an invasive procedure such as laparoscopy. These women often prefer to have IVF, with a good chance for a pregnancy. The efficiency of laparoscopy should not be measured according to the number of pathologies it discovers, but according to the improvement of the outcome from performing the procedure.