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Biomedical subjects

D A Ohl

Publications and source records attributed to D A Ohl.

At least 19 recordsLinked to original sources
PubMed2001

Electroejaculation and assisted reproductive technologies in the treatment of anejaculatory infertility.

OBJECTIVE: To determine the efficacy of electroejaculation in combination with assisted reproductive technology (ART). DESIGN: Case series. SETTING: University fertility program. PATIENT(S): One hundred twenty-one consecutive couples seeking treatment of anejaculatory infertility. INTERVENTION(S): Electroejaculation with IUI, or gamete intrafallopian transfer or IVF. MAIN OUTCOME MEASURE(S): Pregnancy and pregnancy outcome. RESULT(S): Fifty-two couples became pregnant (43%), 39 by IUI alone (32.2%). Cycle fecundity for IUI was 8.7%. No difference in cycle fecundity was seen among ovarian stimulation protocols (clomiphene citrate, 7.6%, hMG, 13.2%, and natural cycle, 11.2%). Pregnancy was unlikely when the inseminated motile sperm count was <4 million. Female management protocol and etiology of anejaculation did not affect results. Patients undergoing IVF had higher cycle fecundity (37.2%) than did those undergoing IUI. The rates of spontaneous abortion and multiple gestations were 23% and 12%, respectively. CONCLUSION(S): Electroejaculation with stepwise application of ART is effective in treating anejaculatory infertility. Intrauterine insemination with the least expensive monitoring protocol should be used for most couples, because use of more expensive monitoring did not improve results. It is cost-effective to bypass IUI and proceed directly to IVF in men who require anesthesia for electroejaculation and in those with a total inseminated motile sperm count < 4 million.

Ejaculation↗
PubMed2001

Canine model of infertility after spinal cord injury: time course of acute changes in semen quality and spermatogenesis.

PURPOSE: We established a canine model of subfertility after spinal cord injury and examined the time course of acute changes in semen quality and spermatogenesis after spinal cord injury. MATERIALS AND METHODS: Seven dogs underwent surgical T7 spinal cord injury. Six dogs were used as controls. Electroejaculation and testicular fine needle aspiration were performed at baseline and twice weekly for 3 weeks after spinal cord injury. Semen quality change was examined by standard semen analysis. Spermatogenesis was assessed by flow cytometry of testicular fine needle aspiration in all dogs as well as by testicular histology at study conclusion in 4 controls and 4 spinal cord injured dogs. RESULTS: No significant changes in spinal cord injured dogs were noted before 3 weeks after injury. From baseline to 3 weeks after injury certain changes were evident in spinal cord injured dogs. Mean antegrade sperm motility decreased from 62.9% to 20.1% (p = 0.008), mean total sperm (antegrade plus retrograde total sperm) decreased from 423 to 294 x 106 which was not statistically significant, and the incidence of testicular haploid cells decreased from 75.6% to 48.3% (p = 0.028). No significant change in any parameter was present in control dogs. The mean number of mature spermatids per cross-sectional tubule on final testicular histology was significantly decreased in spinal cord injured dogs compared with controls (13.6 versus 43.9, p = 0.02). CONCLUSIONS: In the canine model tested the dogs readily survived spinal cord injury, electroejaculation was effective for obtaining ejaculate and fine needle aspiration allowed serial examination of spermatogenesis. Three weeks after spinal cord injury but not before 3 weeks sperm motility and spermatogenesis were significantly decreased. However, at the same point this decrease in spermatogenesis was not yet reflected in the total ejaculated sperm count.

Animals↗
PubMed2001

Location of the ureters in relation to the uterine cervix by computed tomography.

OBJECTIVE: Our aim was to determine the distance of the ureter from the cervix and the influence of age and weight on this distance. STUDY DESIGN: The distance of the ureter from the uterine cervix was determined by evaluating the computed pelvic tomograms from 52 women. Age and body mass index were compared to this distance by means of regression analysis. RESULTS: At the most dorsal reflection of the ureter, the average distance from ureter to cervical margin was 2.3 +/- 0.8 cm (range, 0.1-5.3 cm). There was no relationship to age, but there was a linear relationship between this distance and body mass index (R2 = 0.075; P = .049); thus the ureter was slightly more proximal to the cervical margin in heavier women. CONCLUSIONS: In women with apparently normal pelvic anatomy, the average distance between the ureter and cervix is >2 cm. The finding that this distance is <0.5 cm in 12% of the women studied may explain the relatively common occurrence of ureteral injury during hysterectomy. The relationship between body mass index and location is clinically insignificant.

Adolescent↗
PubMed2001

Sphincteric events during penile vibratory ejaculation and electroejaculation in men with spinal cord injuries.

PURPOSE: We investigate internal and external sphincter responses during penile vibratory stimulation and electroejaculation in men with spinal cord injury. MATERIALS AND METHODS: Ejaculation induction with simultaneous recording of external and internal sphincter pressures was performed in 9 spinal cord injured men. Of the patients with upper motor neuron lesions 3 underwent penile vibratory stimulation and 3 underwent electroejaculation. In 3 men who did not respond to PVS, including 1 with upper motor neuron and 2 with lower motor neuron lesions, penile vibratory stimulation and subsequent electroejaculation were performed. RESULTS: In successful penile vibratory stimulation and electroejaculation upper motor neuron cases external sphincter pressure first reached a peak (average 180 cm. H2O) and subsequently decrease followed in 3 to 10 seconds by a peak in internal sphincter pressure (average 178 cm. H2O), which exceeded external sphincter pressure and ejaculation occurred. During electroejaculation, the pattern progressed, despite complete discontinuation of electrical stimulation. In electroejaculation, there was a trend for a more rapid return of external sphincter pressure greater than internal sphincter pressure, which may explain the electroejaculation retrograde fraction. In nonresponders external sphincter pressure never increased to more than 105 cm. H2O in response to penile vibratory stimulation and no ejaculation was induced. In nonresponders to penile vibratory stimulation, electroejaculation induced a typical sustained increase in internal sphincter pressure and external sphincter pressure but at lower peak pressures. CONCLUSIONS: Forceful contraction of the external sphincter followed by contraction of the internal sphincter always precedes ejaculation during electroejaculation and penile vibratory stimulation. Similarities between penile vibratory stimulation and electroejaculation suggest that the latter induces ejaculation via a complex neurological pathway rather than by simple direct end organ stimulation. The sustained nature of the response to electroejaculation suggests that electrical stimulation should be stopped completely during ejaculation to allow more relaxation of the external sphincter, as this may lead to a decrease in the retrograde fraction.

Ejaculation↗
PubMed1999

Fertilization antigen-1 removes antisperm autoantibodies from spermatozoa of infertile men and results in increased rates of acrosome reaction.

OBJECTIVE: To determine if fertilization antigen (FA)-1 will remove autoantibodies from the surface of sperm cells of immunoinfertile men by immune adsorption and permit an increased acrosome reaction (AR). DESIGN: Prospective analytic study. SETTING: University medical center. PATIENT(S): Men from 18 infertile couples with autoantibodies present on their spermatozoa. INTERVENTION(S): Sperm samples after processing were examined for antibody binding and AR before and after adsorption with control medium or FA-1. MAIN OUTCOME MEASURE(S): Sperm-bound antibody was assessed by the immunobead assay (immunoglobulin [Ig] A and IgG) and the AR by induction with ionophore A23187. RESULT(S): Adsorption with FA-1 compared with control medium increased immunobead-free swimming sperm an average of 50% and 76% for IgA and IgG antisperm antibodies, respectively, with 78% and 100% of the 18 semen specimens increasing significantly. The AR rate increased an average of 10.3% compared with control medium and showed improvement in 78% of the sperm samples after FA-1 adsorption. CONCLUSION(S): The FA-1 sperm antigen appears to significantly free sperm cells coated with autoantibodies in the semen of most infertile men examined. Reducing sperm-bound antibodies that inhibited the AR allowed the sperm cells to undergo successful AR induction by calcium ionophore.

Acrosome Reaction↗
PubMed1999

Seminal vesicle aspiration in spinal cord injured men: insight into poor sperm quality.

PURPOSE: In men with spinal cord injury poor quality semen is seen when performing electroejaculation and penile vibratory stimulation. We determined whether sperm stasis within the seminal vesicles is a potential cause of this problem. MATERIALS AND METHODS: Seminal vesicle aspiration was performed immediately before electroejaculation or penile vibratory stimulation in men with aspermia secondary to spinal cord injury. Sperm count and quality of seminal vesicle aspiration and subsequent ejaculation were compared with historical ejaculated counts, ultrasound findings and patient characteristics. RESULTS: Mean total number of right plus left seminal vesicle sperm plus or minus standard deviation was 511 +/- 960 x 10(6). Mean total number of sperm obtained by seminal vesicle plus electroejaculation or penile vibratory stimulation was 918 +/- 1,261 x 10(6). Average motility and viability of the seminal vesicle aspirated sperm were 1.3 and 3.2%, respectively. Average motility of the ejaculated sperm was 26.4% after seminal vesicle aspiration versus 16.3% in previous ejaculation induction procedures performed in the same patients. Seminal vesicle aspirated sperm represented 66% of the total number of sperm obtained during the session and was equal to 49% of the sperm obtained at previous electroejaculation or penile vibratory stimulation sessions. The period of abstinence correlated only with ejaculate count (simple regression p = 0.009). No other clinical characteristics had any effect on sperm count or quality. CONCLUSIONS: Large numbers of poor quality sperm are present within the seminal vesicles of spinal cord injured men and these sperm comprise a large portion of the specimens collected by electroejaculation or penile vibratory stimulation. This phenomenon is independent of the period of abstinence, implicating disordered storage of sperm due to spinal cord injury rather than infrequent ejaculation. The large number of senescent sperm within the seminal vesicles appears to be a primary cause of poor sperm quality in spinal cord injured men.

Adult↗
PubMed1999

Effect of repeated ejaculation on semen quality in spinal cord injured men.

PURPOSE: We evaluate the effect of repeated ejaculations on semen quality in spinal cord injured men. MATERIALS AND METHODS: The study included 19 spinal cord injured men with anejaculation. Semen was obtained by penile vibratory stimulation in the clinic and patients were instructed in the technique. Optimized vibration parameters were used (2.5 mm. amplitude at 100 Hz.). Penile vibratory stimulation was performed at least once a week for 12 months. Semen quality was examined at baseline and every 3 months during the 1-year study period. Hormonal assays were also performed at each visit. In 9 patients unilateral testicular biopsy was done at baseline and at the end of the 12 months. RESULTS: Normal sperm counts and low motility were seen at baseline. No semen parameter significantly changed during the 12 months of repeated ejaculation. All hormonal assays during the entire study were within normal range and no significant change was observed. Of the 9 biopsies 6 (67%) showed normal spermatogenesis at baseline and no convincing qualitative changes in testicular histology were seen after repeated ejaculation. CONCLUSIONS: Repeated ejaculation in spinal cord injured men does not change the typically poor semen quality. Therefore, stagnation in the seminal ducts due to infrequent ejaculation is not the etiology of the poor semen quality in these patients.

Adult↗
PubMed1999

Unilateral obstruction of the vas deferens diagnosed by seminal vesicle aspiration.

Causes of vasal obstruction include vasectomy, inguinal surgery, scrotal surgery, and congenital anomalies. The incidence of unilateral obstruction in various clinical situations is unknown because sperm from the contralateral testicle usually is present in the ejaculate. Vasography is the standard technique used to diagnose a unilateral vas deferens obstruction. We used the technique of seminal vesicle aspiration to accurately diagnose unilateral vas deferens obstruction in a man who had a previous inguinal hernia repaired with mesh. Surgical exploration confirmed the impression of vasal obstruction, and successful vasovasostomy was performed. We believe that seminal vesicle aspiration may be helpful in the diagnosis of unilateral vas deferens obstruction and has potential benefits over vasography.

Adult↗
PubMed1998

Comparison of transurethral versus periurethral collagen injection in women with intrinsic sphincter deficiency.

Two different injection techniques for collagen injection have been described for the treatment of intrinsic sphincter deficiency (ISD) in women: periurethral and transurethral. The purpose of this review was-to compare these two different techniques to determine whether or not one method clearly is superior. Forty-five women, ages 43 to 88 years (mean 67 years), with ISD underwent collagen injection therapy using either the periurethral or transurethral route. A retrospective analysis was performed comparing initial and final incontinence grades, change in daily pad use, initial Valsalva leak point pressure (VLPP), total amount of collagen used, number of treatment sessions performed, anesthesia required, and complications related to injections. Twenty-four patients underwent transurethral injection, and 21 underwent periurethral injection. There was no significant difference in preoperative incontinence grade, initial VLPP, or age between the two groups. At a mean follow-up of 6.3 months, 11 (46%) of the transurethral group were cured, 12 (50%) improved, and 1 (4%) unchanged. The periurethral group with a mean follow-up of 8.8 months experienced a 33% cure rate and 67% improvement rate (p > .05). The average amount of collagen injected was 4.7 cc (1.5-12.5) transurethrally and 10.1 cc (5-20) periurethrally (p < .001). The number of treatment sessions was identical (1.3) regardless of the method used. Complications were minimal [minor bleeding (2), urinary tract infection (1) in periurethral vs. minor bleeding (2), urinary tract infection (1) in the transurethral group, and not significant between the two groups]. Overall, success was equivalent using either method. The amount of collagen injected was significantly more when utilizing the periurethral method. The transurethral method appears to offer similar results as the more commonly described periurethral technique. The transurethral method is an acceptable technique for collagen injection therapy in women.

Adult↗
PubMed1997

Use of electroejaculation in the treatment of ejaculatory failure secondary to diabetes mellitus.

OBJECTIVES: To describe the experience of two male fertility programs using electroejaculation (EEJ) in the management of men with ejaculatory failure secondary to diabetes mellitus. METHODS: Twenty-nine EEJ procedures were performed in 7 diabetic men with ejaculatory failure. Results were reviewed with attention paid to sperm characteristics in both antegrade and retrograde specimens as well as pregnancy rates. RESULTS: Retrograde semen specimens retrieved from the bladder following EEJ contained a mean of 3444.5 million sperm (range 269.2 to 4996 million). Antegrade specimens contained a mean of 698.8 million sperm (range 226.8 to 1961 million). Mean sperm motility was 4% for retrograde specimens (range 0% to 11%) and 7% for antegrade specimens (1% to 15%). In all but 1 case, semen specimens were used for intrauterine insemination. The total number of motile sperm contained in the processed, inseminated specimens ranged from 1 to 87.2 million. In 1 case, the sperm obtained through EEJ was used in an in vitro fertilization procedure. CONCLUSIONS: EEJ can be successfully used to obtain sperm from men with ejaculatory failure due to diabetes mellitus. The procedure requires general anesthesia, and pregnancy rates after intrauterine insemination with the processed sperm are low. Advanced reproductive technologies may offer a feasible alternative, providing higher success rates with fewer procedures.

Diabetes Complications↗
PubMed1997

Retrograde treatment of ureteropelvic junction obstruction using the ureteral cutting balloon catheter.

PURPOSE: We assessed the efficacy and safety of a new cutting balloon catheter to treat symptomatic ureteropelvic junction obstruction in adults. MATERIALS AND METHODS: A total of 32 adults (mean age 40 years, range 18 to 79) underwent retrograde balloon incision for symptomatic ureteropelvic junction obstruction (27 primary and 5 secondary cases). Treatment outcome was based on improvement of symptoms and resolution of obstruction by excretory urography or diuretic renal scintigraphy. RESULTS: A total of 36 retrograde endopyelotomies was performed on 32 patients. Of 4 patients who underwent repeat endopyelotomy 2 had resolution of persistent obstruction. At a mean followup of 14 months (range 3 to 28) 28 of 32 patients (87.5%) were rendered symptom-free and had no obstruction on excretory urography or diuretic renography. Average hospital stay was 1.8 days (range 0 to 6) and the complication rate was 15.6% (postoperative bleeding, fever and ileus). Treatment failed in 4 patients and subsequent open pyeloplasty was successful. CONCLUSIONS: Retrograde balloon incision endopyelotomy appears to be a safe and effective treatment for ureteropelvic junction obstruction.

Adolescent↗
PubMed1997

Electroejaculation versus vibratory stimulation in spinal cord injured men: sperm quality and patient preference.

PURPOSE: We compared semen quality and patient preference between penile vibratory stimulation and electroejaculation in spinal cord injured men. MATERIALS AND METHODS: We treated 11 spinal cord injured men with penile vibratory stimulation and electroejaculation in random order. End points examined were semen analysis, sperm functional assessment, and patient pain scores (1 to 10) and preferred procedure. Differences between the procedures were determined with the paired Student t test. RESULTS: There was no difference in antegrade sperm count but penile vibratory stimulation specimens had greater motility (26.0 versus 10.7%), viability (25.2 versus 9.7%) and motile sperm count (185.0 x 10(6) versus 97.0 x 10(6)). The retrograde sperm count was greater (but not significant) in electroejaculation patients. The total (antegrade plus retrograde) and motile sperm counts were not different. There was no difference in immunobead test (all negative), cervical mucus penetration or sperm penetration assay, although the percent hamster egg penetration approached significance (53.7% for penile vibratory stimulation versus 22.1% for electroejaculation, p = 0.06). There was no difference in the peak blood pressures and no complications were noted. Pain scores were significantly greater for electroejaculation compared to penile vibratory stimulation (5.2 versus 1.7, respectively). All patients preferred penile vibratory stimulation. CONCLUSIONS: There was a slight advantage in sperm quality and a high patient preference in favor of penile vibratory stimulation. Penile vibratory stimulation should be attempted first to induce ejaculation in spinal cord injured men, with electroejaculation reserved for failures.

Cell Survival↗
PubMed1996

Assessment of sperm function and clinical aspects of impaired sperm function.

Fertility is dependent on a complex set of events, involving both male and female components. Normal sperm function involves many steps, including motility, capacitation, acrosome reactivity and, ultimately, fertilization of the oocyte. While male fertility is most often assessed by means of gross semen parameters, infertility may also be caused by abnormal sperm function, and only by performing specific tests of this function, may the reasons for infertility become evident. Specific tests which may be helpful include semen analysis, detailed sperm motility assessment, motility longevity, hypo-osmotic swelling test, mucus penetration assay, acrosome reactivity, antisperm antibody tests, sperm penetration assay and in vitro fertilization. Relatively well-defined syndromes of abnormal sperm function include immunologic infertility, immotile-cilia syndrome, anejaculation and nifedpine-associated infertility.

Animals↗
PubMed1996

Vacuum erection device in spinal cord injured men: patient and partner satisfaction.

OBJECTIVE: To assess the efficacy of and patient and partner satisfaction with a vacuum erection device (VED) to treat erectile dysfunction of spinal cord injury. DESIGN: Case series. SETTING: University hospital outpatient clinic. PATIENTS: Twenty spinal cord injured men with erectile dysfunction and their heterosexual partners, recruited from outpatient population and by advertisement. INTERVENTION: Use of a VED to obtain erections for sexual activity. MAIN OUTCOME MEASURES: Efficacy in obtaining adequate penile erection, and patient and partner satisfaction with the device (survey). RESULTS: At 3 months, 93% of the men and 83% of the women reported rigidity sufficient for vaginal penetration, with an average duration of 18 minutes. These numbers decreased somewhat at the 6-month control. At 6 months, 41% of the men and 45% of the women were satisfied with the device, with premature loss of rigidity during intercourse the most commonly reported complaint. Sixty percent of men and 42% of women indicated an improvement of the sexual relationship. Minor side effects, such as petechiae and penile skin edema, occurred frequently, but there were no complications that required treatment. CONCLUSION: The VED is effective in many couples in the treatment of erectile dysfunction associated with spinal cord injury. The devices were not universally accepted, but had a significant impact on sexual activity and sexual satisfaction for nearly half the couples. Vacuum erection devices should be presented to SCI men along with other options for treatment of erectile dysfunction.

Adult↗
PubMed1996

Penile vibratory stimulation in spinal cord injured men: optimized vibration parameters and prognostic factors.

OBJECTIVE: To study the efficacy of penile vibratory stimulation (PVS) with optimized vibration parameters in spinal cord injured (SCI) men and to examine prognostic factors for success. DESIGN: Case series. SETTING: University hospital outpatient clinic. PATIENTS: Thirty-four consecutive SCI men seeking fertility treatment. INTERVENTION: PVS with optimized vibration parameters to induce reflex ejaculation. MAIN OUTCOME MEASURES: Ejaculatory response; semen analysis. RESULTS: Antegrade ejaculation was seen in 65% of patients. High rates were seen in lesions above T10 (81%) and in presence of hip flexion and bulbocavernosus reflexes (77%). Of men with lesions above T10, those with a penile prosthesis had lower ejaculation rates (40% vs 90%). Average total sperm counts were 968 million, with 26% motility. CONCLUSIONS: High rates of ejaculation are seen with optimized vibration parameters, especially in men with lesions above T10 and intact lower spinal reflexes. A penile prosthesis may impair success with PVS.

Cohort Studies↗
PubMed1996

Procreation after death or mental incompetence: medical advance or technology gone awry?

OBJECTIVE: To review our experience with semen retrieval in men who are incompetent or dead and to formulate general medical, legal, and ethical guidelines for practitioners. DESIGN: Case series and literature review. SETTING: Academic. PATIENT(S): Seven incompetent or neurologically dead individuals in whom sperm retrieval was requested. INTERVENTION(S): Electroejaculation. RESULT(S): Seminal emission was induced in the two men who underwent electroejaculation. Sperm suitable for cryopreservation was obtained in one of these men. Review of the legal and ethical implications of such procedures led to development of general guidelines for determining whether gamete retrieval should be performed when requested. Issues of procreational autonomy, consideration of the decedent's wishes, and assurance of the well-being of any new life created were considered most strongly in the formation of these guidelines. CONCLUSION(S): Although the retrieval of sperm from deceased or incompetent individuals may be achieved readily, it is incumbent upon the practitioner to consider the legal and moral implications of these procedures before proceeding.

Adolescent↗