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L I Lipshultz

Publications and source records attributed to L I Lipshultz.

At least 73 records · Page 4Linked to original sources
PubMed1995

Resident training survey in infertility.

PURPOSE: We characterize infertility training in urology residency programs. MATERIALS AND METHODS: A pilot survey was sent to randomly selected urological training programs. The modified final survey was sent to 126 approved urological residencies in North America. RESULTS: Of the 126 surveys 110 (87%) were returned. Among the programs 38% expressed interest in recruiting a faculty member with expertise in infertility, 32% indicated an inadequate number of patients available to train residents and 56% indicated that their residents were least competent in the treatment of infertile patients compared to the other urological subspecialty disciplines. CONCLUSIONS: This survey confirms the underemphasis of infertility in urological training programs and the need to enhance this training.

Data Collection↗
PubMed1995

The reversibility of anabolic steroid-induced azoospermia.

Anabolic steroid associated male infertility is a little known but potentially treatable form of drug related infertility. We report on a bodybuilder with a 5-year history of steroid use who was azoospermic. He underwent successful gonadotropin replacement and conception was achieved 3 months after therapy was initiated. Important diagnostic and therapeutic considerations in steroid-induced infertility are discussed.

Adult↗
PubMed1995

Development of a new alloplastic spermatocele demonstrating successful sperm retrieval in an animal model.

OBJECTIVE: To create an alloplastic spermatocele capable of repeated sperm aspiration. The alloplastic spermatocele has long been a theoretical solution to infertility for those patients with congenital absence of the vas deferens or irreversible obstruction of the male reproductive ductal system. Recent studies have suggested that sperm from efferent ducts are capable of fertilization. Clinical use of alloplastic spermatoceles for collection of epididymal sperm has resulted in unacceptably low pregnancy rates. Improvement in spermatocele function may occur if a microsurgical anastomosis is performed to the epididymis. DESIGN: A newly designed alloplastic spermatocele was implanted in 17 mature male rabbits. The faceplate of the device had a 0.7-mm orifice, allowing direct precise microsurgical anastomosis to a specific loop of the epididymal tubule. RESULTS: Sperm retrieval was possible in 16/17 (94%) animals. Repeated successful aspirations (total of 73) were performed in all but one animal. The total number of sperm collected per spermatocele averaged 115 x 10(6) (range 0 to 734 x 10(6)). The sperm motility varied widely between animals and specimens, with a maximum average of 21.6% motile sperm/aspirate per animal. All spermatoceles eventually occluded (mean time of occlusion 14 days; range 3 to 30 days). The prostheses with the attached epididymides were examined histologically. CONCLUSIONS: This prototype alloplastic spermatocele allows repeated high density sperm retrieval over a short period of time. Low sperm motility may be less problematic clinically as new techniques of IVF become available.

Animals↗
PubMed1994

The post-vasectomy length of the testicular vasal remnant: a predictor of surgical outcome in microscopic vasectomy reversal.

To identify another preoperative predictor of surgical outcome in vasal reconstruction, we prospectively measured the post-vasectomy length of the testicular vas deferens from the cauda of the epididymis to the site of the vasectomy in 26 patients undergoing vasal reconstruction. Intraoperatively, the vasal fluid was microscopically inspected and classified as whole sperm present or whole sperm absent. The length of the testicular vasal remnant was correlated with the intraoperative status of the vasal fluid. A testicular vasal remnant length greater than 2.7 cm. predicted the presence of fluid with whole sperm present in 30 of 32 testicles (94%). A testicular vasal length of less than 2.7 cm. predicted the presence of fluid without whole sperm in 17 of 20 testicles (85%). The length of the testicular vasal remnant can be measured preoperatively and knowledge of this length may be used to advise patients regarding the likelihood of successful vasal reconstruction.

Humans↗
PubMed1994

Significant medical pathology uncovered by a comprehensive male infertility evaluation.

OBJECTIVE: To determine if there was a specific screening regimen that could identify all patients with significant medical pathology found during a comprehensive male infertility evaluation. DESIGN: A retrospective study. SETTING: Two university-based male infertility clinics. PATIENTS: Thirteen patients with male factor infertility identified with significant medical pathology. MAIN OUTCOME MEASURES: Initial presentation, history, physical examination, semen analysis, and hormone profile. RESULTS: The identification of significant medical pathology was uncovered in 13 of 1,236 patients (1.1%) presenting to a male infertility clinic. The pathology was identified with a thorough history in 4 of 13 patients (30.8%) and by a complete physical examination in 8 of 13 patients (61.5%). Semen analyses were available on 12 patients, and 1 patient was anejaculatory. Two patients were azoospermic. Of the patients with sperm present, the mean sperm concentration was 8.6 x 10(6)/mL (range, 0.8 to 27), and the mean sperm motility was 32.0% (range, 0% to 65%). In 5 patients, endocrine abnormalities were specifically related to the subsequent pathology identified. A tumor was identified in 10 patients (6 testicular tumors, 3 brain tumors, and 1 spinal cord tumor). Two patients had ejaculatory dysfunction as a result of mesonephric duct anomalies affecting the ejaculatory duct or bladder neck closure. One patient had Klinefelter's syndrome. CONCLUSIONS: There was no pathognomonic finding on history, physical examination, semen analysis, or hormone profile that identified all patients with significant medical pathology. The significant medical pathology identified was represented in all semen quality groupings, that is, azoospermia, severe oligospermia, mild oligospermia, and normospermia. We recommend a comprehensive urologic evaluation for all male partners of infertile couples with a male factor or unexplained infertility in an attempt to identify significant and potentially treatable medical pathology before engaging in a series of therapies with assisted reproductive techniques.

Adult↗
PubMed1994

Immunologic infertility.

The existence of immunologic infertility is well grounded in the theories of humoral and cell-mediated immunology. Both of these immune system arms can theoretically and experimentally be shown to play roles in states of male factor infertility. Although much progress has been made in relating immunopathology to infertility, several problems plague the investigation and diagnosis: the use of multiple, different assay systems; the lack of properly controlled experimental work; a need to oversimplify a tremendously complex immunologic network for clinical purposes; and a dearth of communication between basic science and clinical investigators. Unlike the established role of humoral or antibody-mediated infertility, the way cell-mediated immunity induces reproductive failure is just beginning to be understood. Two active areas of investigation include a delineation of active immunosuppression in the normal testicular environment and the pathologic deficits induced by cytokines in cases of leukospermia. Other research seeks to define functional, sperm-specific antigens to which autoantibodies are directed and to elucidate the mechanisms of antibody-mediated infertility at various sites in the reproductive tract. The diagnosis of immunologic infertility still remains one of exclusion. When the diagnosis is made, it is necessary to define precisely which functional reproductive deficits exist, through an analysis of semen parameters, postcoital tests, sperm penetration assays, and tests of acrosomal reactivity. This is essential because the therapeutic options are broad and can involve significant side effects and expense. Proven modalities include sperm manipulation, direct sperm insemination, donor insemination, systemic immunosuppression, and assisted reproductive techniques.(ABSTRACT TRUNCATED AT 250 WORDS)

Autoantibodies↗
PubMed1994

Nonsurgical treatment of male infertility. An update.

As has been shown, when well-defined pathophysiology such as hypogonadotropic hypogonadism exists in subfertile men, reasonably successful treatment options are available. When subfertility is unexplained or idiopathic, treatment is less successful. At present, numerous conditions of varying pathophysiology are lumped together as "idiopathic subfertility" and treated with the same nonspecific therapeutic modalities with minimal success. As further research elucidates the biochemical abnormalities causing these conditions, rational and specific therapies may be developed. In addition, advances in assisted reproductive technologies will allow treatment for many patients for whom no therapy currently exists.

Fertility Agents, Male↗
PubMed1993

Varicocele: a progressive or static lesion?

Varicoceles are associated with ipsilateral testicular atrophy in the adolescent. To determine if varicoceles are capable of causing progressive loss of fertility, we conducted a date-matched, retrospective study. We reviewed 2,989 patients evaluated for infertility at our institution from 1985 to 1990. A total of 285 (8.5%) patients were diagnosed with secondary infertility. A varicocele was identified as the cause of the patient's infertility in 177 (69%) men with secondary infertility. When matched by date to an identical number of men with primary infertility in whom 128 (50%) were infertile on the basis of a varicocele effect, the difference was significant (p < 0.0001). We conclude that a varicocele in some men is a progressive and not a static lesion resulting in the loss of previously established fertility. In addition, varicoceles are not only the leading cause of infertility in men with secondary infertility, but also occur with a greater frequency than in men with primary infertility.

Humans↗
PubMed1993

Evaluation and treatment of ejaculatory duct obstruction in the infertile male.

OBJECTIVE: To evaluate the role of ejaculatory duct obstruction as a cause for male factor infertility and review the treatment of this condition. DESIGN: A retrospective study was carried out involving male patients diagnosed as having ejaculatory duct obstruction as a contributing cause for their subfertility. SETTING: Patients were evaluated and treated through a university-based male infertility clinic. PATIENTS, PARTICIPANTS: Patients were evaluated for the presence of ejaculatory duct obstruction if they suffered from decreased ejaculate volume, sperm density, and sperm motility but had normal physical examinations and otherwise normal laboratory evaluations. INTERVENTIONS: Patients were treated by transurethral resection of the ejaculatory ducts. MAIN OUTCOME MEASURES: Results of semen analysis and pregnancy rates. RESULTS: An alteration in semen quality was achieved in 79% of patients after transurethral resection. An increase in sperm density or motility was achieved in 50%, whereas 29% showed an increase in ejaculate volume only. Pregnancy rate postoperatively was 29%. CONCLUSIONS: Ejaculatory duct obstruction as a cause of male infertility is more common than was previously recognized, especially among nonazoospermic patients. In properly selected patients, transurethral resection of the ejaculatory ducts can result in marked improvement in semen quality with subsequent pregnancy.

Constriction, Pathologic↗
PubMed1993

A neural network to analyze fertility data.

OBJECTIVE: To program an artificial intelligence system, a neural network, and use it to predict results of sperm penetration in bovine cervical mucus (Penetrak assay; Serono Laboratories, Norwell, MA) and zona-free hamster egg penetration from the semen analysis. DESIGN: Results of 139 Penetrak assays, 1,416 zona-free hamster egg penetration assays, and the corresponding semen analyses were retrospectively analyzed by an artificial neural network. MAIN OUTCOME MEASURES: Classification errors of the neural network were compared with those of linear and quadratic discriminant function analyses. RESULTS: Data were separated into training and test sets. For the Penetrak result, linear and quadratic discriminant function analysis correctly predicted 58% and 74% of the training set results and only 64.1% and 69.2% of the test data, respectively. The neural network correctly predicted 92% of training set results and 80% of test set results. For the zona-free hamster egg penetration assay outcome, linear and quadratic discriminant function analysis correctly classified 66.3% and 46.0% of the training set and 64.9% and 44.7% of the test set, respectively. The neural network correctly classified 75.7% of the training data and 67.8% of the test data. CONCLUSIONS: Using the semen analysis, the neural network correctly classified 67.8% of zona-free hamster egg penetration assay results and 80% of Penetrak results it had not encountered previously, suggesting that this method of data analysis may be successfully employed to predict fertility potential.

Animals↗
PubMed1993

Tests of sperm function for evaluation of the male: Penetrak and Tru-Trax.

OBJECTIVE: To evaluate the Penetrak (Serono Laboratories, Norwell, MA) and Tru-Trax (Humagen, Charlottesville, VA) bovine cervical mucus (CM) penetration assays and to correlate results to parameters of semen analysis and male factor diagnosis. DESIGN: Prospective, nonrandomized, controlled study. PARTICIPANTS: Two hundred thirty-six males undergoing evaluation for male factor infertility and 37 fertile semen donors. MAIN OUTCOME MEASURES: Human sperm penetration in bovine CM measured by the Penetrak and Tru-Trax assay systems correlated to sperm density, motility, forward progression, and clinical diagnosis. RESULTS: Two parameters of semen analysis, motility and density were correlated to the distance traversed by the vanguard sperm in both Penetrak and Tru-Trax assays. Penetrak results were significantly correlated to male factor infertility diagnosis. CONCLUSIONS: Both assays were reliable and highly reproducible, and the Tru-Trax assay was correlated to its predecessor, Penetrak. Although Penetrak and Tru-Trax were correlated to motility and density, no correlation coefficient was > 0.6, suggesting that these assays measure a facet of sperm function that is independent of semen analysis.

Animals↗
PubMed1993

Reassessment of male-factor infertility, including the varicocele, sperm penetration assay, semen analysis, and in vitro fertilization.

Evaluation of the male factor in infertility is becoming increasingly important as new diagnostic techniques and therapeutic options become available. Varicoceles are among the most common treatable cause of male infertility. Varicoceles are present in 10% to 20% of all males but are found in as many as 30% to 40% of men who present to an infertility clinic. Of men who have treatment for varicoceles, 50% to 75% will show some improvement in semen quality, and 30% to 40% will initiate a pregnancy. We review some controversial issues related to the diagnosis and treatment of varicoceles. In vitro fertilization, originally developed for the female with irreversible tubal damage, is now being evaluated as a possible therapy for severe male-factor infertility that has failed to respond to routine surgical or medical treatment. In vitro fertilization for the oligospermic male, however, is further complicated by the fact that men with poor sperm production frequently have poorly functioning sperm as well. Consequently, we discuss the value of the sperm penetration assay, with and without enhancement techniques to prospectively evaluate couples entering in vitro fertilization programs. We also discuss the role of strict criteria for determination of sperm morphology and quantitation of leukocytospermia in the evaluation of the infertile male. Finally, evaluation of the predictive value of "failure to fertilize" at in vitro fertilization for future in vitro fertilization success is discussed.

Female↗
PubMed1992

Impact of cyclophosphamide on long-term reduction in sperm count in men treated with combination chemotherapy for Ewing and soft tissue sarcomas.

BACKGROUND: Treatment of cancer with multiple-drug chemotherapy regimens or radiation therapy can cause either temporary azoospermia of various durations or permanent azoospermia in young men. METHODS: To identify which drugs in which doses contribute to long-term or permanent azoospermia, semen analyses were done on patients with Ewing and soft tissue sarcomas before, during, and after treatment with either CYADIC (cyclophosphamide, doxorubicin, and dacarbazine), or CYVADIC (vincristine added to CYADIC). Some patients also received other drugs or radiation therapy. RESULTS: From pretreatment levels that were similar to those of control subjects, sperm production declined to azoospermia within 4 months of treatment. Sperm production returned in some patients after treatment; 40% of men recovered to normospermic levels by 5 years after treatment. Few patients showed continued recovery of sperm production after that time. The cumulative dose of cyclophosphamide was the most significant determinant of recovery to normospermic levels; approximately 70% of those who had received doses less than 7.5 g/m2 (median, 4.1 g/m2) recovered, but only 10% recovered when doses exceeded 7.5 g/m2. CONCLUSIONS: Thus, a risk of permanent sterility is associated with the use of the CYADIC and CYVADIC regimens in young men, especially when the cumulative dose of cyclophosphamide is greater than 7.5 mg/m2.

Adult↗
PubMed1992

Transrectal ultrasound and partial ejaculatory duct obstruction in male infertility.

Partial ejaculatory duct obstruction, due to either a congenital or an acquired cyst or ejaculatory duct stenosis secondary to calcification, chronic inflammation, can produce a wide spectrum of seminal fluid abnormalities. Sperm density may range from azoospermia to normospermia while ejaculate volume can be low to normal. Sperm motility is consistently diminished (less than 30%). We have treated 2 patients with ejaculatory duct stenosis whose diagnosis was accurately made with transrectal ultrasonography (TRUS). We now suggest that TRUS be used when there is a low semen volume (less than 1.0 cc), or low motility (less than 30%), or oligospermia (less than 20 million sperm/mL), and normal findings on physical examination with normal serum gonadotropin values in the absence of any other explanation.

Adult↗
PubMed1992

Incidence of sperm with two fluorescent bodies in men with impaired fertility.

OBJECTIVE: To determine the two fluorescent body (2FLB) frequency in males with impaired fertility. DESIGN: Males of couples were evaluated along with their female partners for reproductive function. They were classified as having the potential for fertility (control group) or as infertile (test group). This was based on the evaluation of both members of the couple. Semen parameters were determined and analyzed for differences among diagnostic groups. SETTING: The setting was clinical secondary care in both private and institutional practice. PATIENTS, PARTICIPANTS: The study population was composed of males of couples who were being evaluated for infertility. Classification as to reproductive potential and categories of abnormality was based on measurement of semen parameters and clinical judgment. INTERVENTIONS: Semen specimens were obtained and analyzed from 78 control and 93 test subjects. MAIN OUTCOME MEASURES: Semen parameters including volume, sperm count, sperm motility, percent morphologically abnormal sperm, and percent of quinacrine-stained sperm containing zero, one, or two FLBs were determined. RESULTS: The test group was found to have a 2FLB frequency that was significantly different from that of the control group. The data were then analyzed for significant differences in 2FLB frequencies in subpopulations. When subjects from all diagnostic subgroups that included varicocele were compared with the controls, the 2FLB frequency was significantly elevated (median percent of 2FLB was 1.2 versus 0.7). The 2FLB frequency in the remaining diagnostic groups was not elevated. CONCLUSIONS: This is the first report of an elevated 2FLB frequency associated with a biological abnormality. The cause of the elevated 2FLB frequency is not known. However, other anomalies that have been identified in varicocele patients have been associated with elevated intrascrotal temperatures. There are data available that associates elevated temperature with aneuploidy in mouse oocytes.

Humans↗
PubMed1992

The effect of semen quality of the electrical current and heat generated during rectal probe electroejaculation.

Rectal probe electroejaculation is effective in procuring sperm from spinal cord injured patients with ejaculatory incompetence. The seminal quality in these patients is usually suboptimal and the motility is almost always low. We conducted an in vitro experiment to determine whether the heat and current generated during rectal probe electroejaculation impaired sperm motility or forward progression, or if the poor semen quality is the result of existing testicular dysfunction.

Ejaculation↗