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At least 487 records · Page 27Linked to original sources
PubMed1997

Pregnancy after assisted ejaculation procedures in men with spinal cord injury.

OBJECTIVE: To present the results of fertility treatment in 28 men with spinal cord injury (SCI) and their partners. DESIGN: Retrospective analysis. SETTING: University hospital outpatient clinic and home. PATIENTS: Twenty-eight anejaculatory men with SCI and their partners seeking treatment for infertility. INTERVENTION: Penile vibratory stimulation and electroejaculation as semen retrieval methods. Assisted reproductive techniques used: vaginal self-insemination at home, intrauterine insemination, in vitro fertilization with or without intracytoplasmic sperm injection. MAIN OUTCOME MEASURES: Ejaculation rate; sperm count and motility; pregnancy rates. RESULTS: All of the men were able to ejaculate either by penile vibratory stimulation (79%) or electroejaculation (21%). Median total sperm count was 65 million (range, 0.1 to 480) with a median motility of 13% (range, 1% to 60%). Overall, 9 of 28 couples (32%) achieved 10 pregnancies (4 self-insemination, 3 intrauterine insemination, 1 in vitro fertilization, and 2 intracytoplasmic sperm injection). CONCLUSIONS: An ejaculation rate of 100% was achieved using penile vibratory stimulation as a first treatment option with electroejaculation as a second option. Motivated couples with adequate semen quality may be offered penile vibratory stimulation combined with self-insemination at home. Together with intrauterine insemination or fertilization techniques used in vitro, the pregnancy rate per treatment cycle for SCI couples may approach that of natural procreation in healthy and fertile couples.

Adult↗
PubMed1998

Side effects of chronic intrathecal baclofen on erection and ejaculation in patients with spinal cord lesions.

OBJECTIVE: Assess modifications of sexual function in men treated with intrathecal baclofen for spinal spasticity. DESIGN: Prospective before-after trial. SETTING: A rehabilitation department of a university hospital; follow-up was on an outpatient basis. PATIENTS: A convenience sample of nine consecutively recruited men with spinal cord injury or multiple sclerosis who were receiving intrathecal baclofen by an implantable pump; average follow-up was 44.4 months. MAIN OUTCOME MEASURES: A questionnaire focusing on: libido; ability to sustain reflexive and psychogenic erections; rigidity, evaluated by a visual analog scale; maximum duration of erection; possibility of ejaculation. RESULTS: Libido and the ability to obtain psychogenic or reflexogenic erections were not modified. However, eight patients reported a decrease of erection rigidity and/or duration. Ejaculation was possible in three cases before implantation. It disappeared in two patients, and was more difficult to obtain in the last one. It reappeared after treatment withdrawal. No differences were found between multiple sclerosis and spinal cord injured patients. CONCLUSION: Intrathecal baclofen may compromise erection and ejaculation. This effect is reversible. Patients should be informed of this effect.

Adult↗
PubMed2003

Evidence for the involvement of a spinal pattern generator in the control of the genital motor pattern of ejaculation.

One of the hypotheses to explain the neural mechanisms underlying rhythmic behaviours suggests that the central nervous system has the intrinsic capacity to produce repetitive, rhythmic output to the muscles involved in the response by means of a neuronal circuit named central pattern generator (CPG). The occurrence of rhythmic motor patterns during ejaculatory behaviour in mammals, which includes the genital motor pattern, has been shown. A CPG might regulate the timing of the repetitive muscular responses that constitute the ejaculatory motor pattern. The objective of the present study was to evidence that a CPG at a spinal level is involved in the expression and pacing of the rhythmic motor pattern generated during ejaculation. To this purpose we used the genital reflex as a model system. Following the general principles for the study of rhythmic motor patterns, the data obtained in the present series of experiments document that: (1) a rhythmic muscular response, the genital motor pattern, is registered during the ejaculatory event (expulsion of the urethral contents); (2) this ejaculatory motor response has similar EMG characteristics in intact and in spinal urethane-anaesthetised male rats; (3) interruption of the afferent inflow (deafferentation) does not disrupt the expression of the ejaculatory motor train; (4) a change in the stimulation interval does not alter the intrinsic pacing of the ejaculatory-like response; and (5) fictive ejaculation can be induced by pharmacological means. Together, this evidence supports the notion that a CPG produces the rhythmic ejaculatory motor pattern registered during fictive ejaculation.

8-Hydroxy-2-(di-n-propylamino)tetralin↗
PubMed2000

A comparison of the morphology of testicular, epididymal, and ejaculated sperm from fertile men and men with obstructive azoospermia.

OBJECTIVE: To assess the morphology of testicular, epididymal, and ejaculated sperm. DESIGN: Morphology of the three types of sperm was assessed by using Tygerberg strict criteria. SETTING: The Regional Fertility Center, Royal Maternity Hospital, Belfast, Northern Ireland, United Kingdom. PATIENT(S): Thirty-two men with obstructive azoospermia and 10 fertile men. INTERVENTION(S): Trucut needle testicular biopsy and percutaneous epididymal sperm aspiration under local anesthetic. MAIN OUTCOME MEASURE(S): Percentages of normal sperm and sperm with head, midpiece, and tail defects for testicular, epididymal, and ejaculated sperm. Testicular sperm morphology in men with obstructive azoospermia was compared with that of fertile men. RESULT(S): The percentage of normal testicular sperm (4.3%) differed significantly from the percentages of normal epididymal (10. 8%) and ejaculated sperm (9.6%). Testicular sperm morphology in men with obstructive azoospermia did not differ from that in fertile men. CONCLUSION(S): Tygerberg strict criteria are not suitable for the assessment of testicular sperm morphology.

Ejaculation↗
PubMed1976

Retrograde ejaculation: pathophysiologic aspects and report of two successfully treated cases.

The ejaculatory process consists of two stages. During the first stage the semen is pumped into the posterior urethra and during the second stage the semen is propelled via the urethra through the external meatus. A pathologic second stage may lead to retrograde ejaculation of the semen into the urinary bladder. Attempts to achieve fertility in such patients can be made in two ways; namely through procedures to restore antegrade ejaculation (mainly using alpha-sympathomimetic agents) and procedures to regain viable and fertile sperm from the urinary bladder after sexual intercourse, with subsequent artificial insemination. The latter way of treatment was used in two patients who were referred for infertility and in whom retrograde ejaculation had been diagnosed. Postcoital urinary specimens were obtained by micturition and centrifuged. In one patient the sediment was washed with a nutrient solution; the other patient received alkalizing agents prior to intercourse in order to neutralize the urinary pH. The wives were inseminated on appropriate days and conceived. Both delivered healthy babies after uneventful pregnancies.

Adult↗
PubMed1984

Retrograde ejaculation: etiology and treatment via the use of a new noninvasive method.

Retrograde ejaculation (RE) is not a common infertility problem, but has increased in incidence recently due to surgical aggressiveness in pelvic and genital malignancies. However, RE is the most common cause of aspermia, or absence of ejaculate at orgasm. Meanwhile, surgical or drug therapy methods have not been very promising in regaining normal antegrade ejaculation. As yet, the standard procedures for treatment of RE involve the artificial insemination of either nonprocessed or processed (via centrifugation and resuspension) postcoital voided bladder contents. RE specimens in this study were collected after postcoital voiding into a TEST buffer and resuspended in TEST-yolk buffer. The urine effects on the voided spermatozoa were studied. The technique employed in this study assists in the recovery and reconstitution of RE fit for artificial insemination.

Adult↗
PubMed1995

Successful establishment of pregnancy by superovulation and intrauterine insemination with sperm recovered by a modified Hotchkiss procedure from a patient with retrograde ejaculation.

OBJECTIVE: To improve the quality of the sperm recovered from the bladder in a patient with retrograde ejaculation who already had failed to conceive after several attempts at IUI with sperm recovered by conventional techniques. SETTING: University Hospital. PATIENTS: A couple with male infertility due to retrograde ejaculation caused by the Zielke operation, a spinal fixation procedure performed to correct severe kyphoscoliosis. INTERVENTION: Superovulation and IUI of sperm recovered from the bladder using a modified Hotchkiss procedure involving the introduction into the bladder of Earle's balanced salt solution (EBSS) buffered with Hepes in sufficient quantity to bring the urinary pH and osmolarity to those of fresh ejaculate. MAIN OUTCOME MEASURES: Urine pH and osmolarity at baseline and after dilution with EBSS buffered with HEPES. Concentration, motility, and progression score of the sperm recovered from the bladder. RESULTS: Good sperm samples were achieved. Pregnancy was established when IUI was performed in association with superovulation induction. CONCLUSIONS: Determination of urine pH and osmolarity appears to be a useful method for choosing the ideal sperm recovery procedure. The modified Hotchkiss procedure described seems to be a promising alternative method for recovering sperm for artificial insemination.

Adult↗
PubMed1988

Successful pregnancies from men with retrograde ejaculation with the use of washed sperm and gamete intrafallopian tube transfer (GIFT).

Viable sperm were collected from men suffering from retrograde ejaculation by the technique of rapid washing of semen/urine in a buffered collection solution. The utilization of washed semen/urine from two men with retrograde ejaculation in the GIFT procedure lead to successful conceptions and the birth of two healthy female babies. Thus, the technique of rapid washing of sperm from retrograde ejaculating men coupled with GIFT represents a viable alternative for the attainment of pregnancy.

Ejaculation↗
PubMed1997

Pregnancy and birth after intracytoplasmic sperm injection with totally immotile sperm recovered from the ejaculate.

OBJECTIVE: To report the birth of two healthy children after intracytoplasmic sperm injection (ICSI) with totally immotile spermatozoa recovered from the ejaculate. DESIGN: Retrospective case report. SETTING: University-based hospital. PATIENT(S): Four couples in whom spermatozoa recovered from the ejaculate were totally immotile but presented normal vitality scores. INTERVENTION(S): Therapeutical IVF-ET attempts coupled with ICSI. MAIN OUTCOME MEASURE(S): Fertilization and pregnancy results after ICSI. RESULTS: With random sperm injection, 19 of the 36 injected oocytes showed normal fertilization and cleavage. One of four patients had a twin pregnancy that resulted in birth of two healthy children. CONCLUSION(S): In cases in which totally immotile ejaculated sperm present normal vitality scores, normal clinical outcomes can be achieved by using the usual random sperm selection during conventional ICSI.

Abortion, Spontaneous↗
PubMed1998

Successful pregnancy with sperm retrieved from the bladder after the introduction of a low-electrolyte solution for retrograde ejaculation.

OBJECTIVE: To determine the safety and efficacy of the introduction of a low-electrolyte solution into the bladder before masturbation for sperm recovery in patients with retrograde ejaculation. DESIGN: Two case reports. SETTING: Assisted reproduction practice at a university hospital. PATIENT(S): Two men with retrograde ejaculation. INTERVENTION(S): A 0.32-mol/L glucose solution or Ham's modified F-10 medium (GIBCO, Grand Island, NY) with 10% serum was introduced into the urinary bladder before masturbation. The retrieved sperm were used for IUI. MAIN OUTCOME MEASURE(S): The motility of retrieved sperm, achievement of pregnancy, and outcome of pregnancy. RESULT(S): In patient 1, the motility rate of sperm retrieved from the bladder after the introduction of Ham's modified F-10 medium was higher than that after the introduction of a glucose solution. The patient's wife did not become pregnant during 10 IUI cycles after treatment with Ham's modified F-10 medium. However, she became pregnant during the first IUI cycle after treatment with a glucose solution and was delivered of healthy twin infants. The wife of patient 2 also became pregnant during the first IUI cycle after treatment with a glucose solution and was delivered of a healthy female infant. CONCLUSION(S): The introduction of a glucose solution appears to be a safe and simple method for sperm recovery in patients with retrograde ejaculation.

Adult↗
PubMed2002

A prospective study comparing paroxetine alone versus paroxetine plus sildenafil in patients with premature ejaculation.

PURPOSE: We compared the efficacy of paroxetine alone and combined with sildenafil in patients complaining of premature ejaculation. MATERIALS AND METHODS: Enrolled in this study were 80 consecutive potent men 19 to 47 years old (mean age 34) with premature ejaculation but without any obvious organic cause. Pretreatment evaluation included a history, self-administration of the International Index of Erectile Function (IIEF) questionnaire, physical examination and the Meares-Stamey test to exclude genital tract infection. The initial 40 patients received 10 mg. paroxetine daily for 21 days and then 20 mg. as needed, that is 3 to 4 hours before planned sexual activity, for 6 months (group 1). The other group of 40 men received 10 mg. paroxetine daily for 21 days and then 20 mg. as needed plus 50 mg. sildenafil as needed, that is 1 hour before planned sexual activity, for 6 months (group 2). Patients were followed 3 and 6 months after beginning therapy and were evaluated using several general assessment questions, IIEF and ejaculatory latency time. RESULTS: Mean ejaculatory latency time +/- SE in group 1 was 0.33 +/- 0.04, 3.7 +/- 0.10 (p <0.01) and 4.2 +/- 0.03 (p <0.01) minutes at baseline, 3 and 6-month followup, while in group 2 it was 0.35 +/- 0.03, 4.5 +/- 0.07 (p <0.01) and 5.3 +/- 0.02 (p <0.001) minutes, respectively. When improvement in ejaculatory latency time was compared in the 2 groups, group 2 results proved to be significantly greater (p <0.05). Baseline, and 3 and 6-month mean intercourse satisfaction domain values of the IIEF were 9, 11 and 11 (p = 0.09, not significant), and 9, 11 and 14 (p <0.05) in groups 1 and 2, respectively. Group 2 patients reported significantly greater intercourse satisfaction than those in group 1 (p <0.05). At baseline, 3 and 6 months there was a mean of 0.9 +/- 0.1, 1.7 +/- 0.3 (not significant) and 2.5 +/- 0.3 (p <0.01) coitus episodes weekly in group 1, and 1 +/- 0.2, 2.3 +/- 0.3 (p <0.01) and 3.2 +/- 0.1 (p <0.001) in group 2, respectively. Group 2 patients reported a significantly higher number of coitus episodes weekly (p <0.05). Side effects in the 40 group 1 cases included anejaculation in 1 (2.5%), gastrointestinal upset and/or nausea in 5 (12.5%), headache in 4 (10%) and decreased libido in 2 (5%). Side effects in the 40 group 2 cases included anejaculation in 1 (2.5%), headache in 8 (20%), gastrointestinal upset and/or nausea in 6 (15%) and flushing in 6 (15%). Group 2 patients reported significantly more headaches (p <0.01) and flushing episodes (p <0.001) than those in group 1. After 6 months of treatment 33 men (82.5%) in group 1 and 36 (90%) in group 2 were willing to continue therapy (not significant). CONCLUSIONS: Paroxetine combined with sildenafil appears to provide significantly better results in terms of ejaculatory latency time and intercourse satisfaction versus paroxetine alone in potent patients with premature ejaculation. However, combined treatment is associated with a mild increase in drug related side effects.

Adult↗
PubMed1993

The impact of ejaculation on serum prostate specific antigen.

In a pilot study including 18 patients between 20 and 39 years old serum prostate specific antigen (PSA) was evaluated before as well as 1 and 7 days after ejaculation. In 13 patients who had more than 0 ng./ml. PSA before ejaculation (mean 1.44 ng./ml.) there were statistically significant decreases in serum PSA down to 0.17 ng./ml. and 0.29 ng./ml., respectively (p = 0.0001). These results suggest a physiological relationship between ejaculation and decreased serum PSA levels. Due to the clinical significance of PSA in the diagnosis and monitoring of prostate cancer, further studies are needed including men of risk age and untreated prostate cancer patients.

Adult↗
PubMed1993

The value of quantitative testicular biopsy and deoxyribonucleic acid flow cytometry in predicting sperm recovery from electrostimulated ejaculates.

Spermatogenic abnormalities have been reported in the majority of men following spinal cord injury, and they contribute to the multifactorial etiology of reproductive dysfunction. Thus far, few have studied the seminiferous epithelium in this group of patients by objective criteria. While quantitative micrometry and flow cytometric analysis are accurate and reproducible methods of quantitating spermatogenesis, the latter is simpler and permits needle aspiration for tissue recovery. The objective of this study is to determine the value of quantitative micrometry and flow cytometric analysis as methods of predicting total sperm yield in electrostimulated ejaculates. Incisional testicular biopsy was performed in 12 anejaculatory men, and the tissue specimens were divided for analysis by quantitative micrometry and flow cytometric analysis. Quantitative micrometry consisted of determining the mean tubular wall thickness, mean tubular concentration of the Sertoli cells and mature spermatids in a minimum of 10 round seminiferous tubules per patient. Specimens were prepared for flow cytometric analysis and the deoxyribonucleic acid histogram was analyzed to determine the percentage of cells in each ploidy compartment. Of the quantitative micrometry parameters analyzed a significant correlation resulted between the total sperm yield per electroejaculate and the mean tubular concentration of late spermatids (p = 0.001) as well as with the mean tubular ratio of late spermatids to Sertoli cells (p = 0.003). The tubular concentration of spermatids resulted in a sensitivity and specificity of 100% and 75%, respectively, to predict adequate sperm yield in semen. Likewise, the mean tubular ratio of spermatids to Sertoli cells resulted in a sensitivity and specificity of 75% and 87.5%, respectively, in its ability to predict normal sperm yield in the recovered ejaculate. Deoxyribonucleic acid flow cytometry analysis showed a normal haploid compartment in all 6 specimens studied, and each was associated with high numbers of sperm in recovered semen. Quantitative histometric parameters correlate significantly with the total sperm yield obtained in electrostimulated ejaculates and may have a role in the selection of candidates for treatment in reproductive rehabilitation programs.

Biopsy↗
PubMed1993

Preservation of ejaculation through a modified retroperitoneal lymph node dissection in low stage testis cancer.

We studied ejaculatory function in 47 patients who underwent modified retroperitoneal lymph node dissection for nonseminomatous germ cell tumors of the testis from 1983 to 1989. Our goal was to assess the effectiveness of a modified node dissection in preserving ejaculatory function while eliminating the risk of retroperitoneal recurrence. There were 13 left and 34 right tumors. Of the patients 45 had clinical stage A cancer, and 2 had clinical stage B2 disease and received preoperative chemotherapy. The template method of dissection was used, which spares the preaortic area below the inferior mesenteric artery, including the sacral promontory. Average operating time was 3 hours 40 minutes. There was no operative mortality. Spontaneous recovery of ejaculation occurred in 38 patients (81%), more commonly with right (88%) than with left dissections (62%). The mean interval to recovery of ejaculation was 5 months (92% within 12 months). Five patients (10%) had recurrence, with a mean followup of 28 months. All recurrences were in the lungs 4 to 8 months after retroperitoneal lymph node dissection, and all patients were salvaged with chemotherapy and are disease-free. We confirmed that a modified template-type retroperitoneal lymph node dissection can be accomplished safely with preservation of ejaculation in more than 80% of the patients without increasing the risk of local recurrence.

Adult↗
PubMed1992

A mechanism of retrograde ejaculation after bilateral hypogastric nerve transections in the dog.

To pursue the mechanism of retrograde ejaculation after bilateral hypogastric nerve transections, the disability of the lumbosacral sympathetic trunk and the spermatic nerve to compensate bladder neck closure was investigated while both act as compensatory pathways for seminal emission. Five mongrel dogs were used for each experiment. By manual penis-stimulation, all dogs showed only retrograde ejaculation one month and six months after transection of bilateral hypogastric nerves. Bladder neck closure did not occur by electrical stimulation of either the lumbosacral sympathetic trunk or the spermatic nerve before and one month after transection of bilateral hypogastric nerves in all dogs examined and persistent relaxation of bladder neck was observed one and six months after transection of bilateral hypogastric nerves. The present results and our previous data indicate that retrograde ejaculation after bilateral hypogastric nerve transections is attributable to the absence of effective compensatory sympathetic pathways for bladder neck closure under the recovery of seminal emission by compensatory pathways.

Animals↗
PubMed1990

Ultrasonographic characteristics of the seminal vesicles after ejaculation.

A total of 12 men from a sperm donor bank underwent transrectal ultrasonography before and after ejaculation to investigate possible changes that could influence interpretation of seminal vesicle ultrasonography. The mean length of the seminal vesicles was 2.98 cm. before and 2.95 cm. after ejaculation. The anteroposterior diameter decreased only from 0.59 to 0.52 cm. Minimal differences were noted between the right and left seminal vesicles, and the greatest variation in size in an individual was only 3 mm. These results indicate that interpretation of seminal vesicle anatomy as seen by ultrasonography does not depend upon the temporal relationship to ejaculation.

Adult↗
PubMed1988

Retroperitoneal lymphadenectomy for testis tumor with nerve sparing for ejaculation.

The principal morbidity of retroperitoneal lymphadenectomy is the potential loss of ejaculation and, therefore, fertility owing to damage of the retroperitoneal sympathetic nerves that form the superior hypogastric plexus. We describe the results of our retroperitoneal lymphadenectomy when individual nerves from the sympathetic ganglia are identified and preserved while still performing a thorough bilateral retroperitoneal lymphadenectomy. The nerve-sparing procedure was technically feasible in 20 of 30 consecutive patients and it was only impractical with extensive gross disease. Of the 20 patients 18 (90 per cent) ejaculate, including 8 with bulky (5 cm. or more) residual retroperitoneal disease who underwent a successful nerve-sparing operation. All 12 patients (100 per cent) with nonbulky disease ejaculate. With short followup, no retroperitoneal recurrences have been detected. This technique is an alternative to limited dissection designed to spare nerves using boundaries based on the patterns of metastatic involvement.

Ejaculation↗
PubMed1986

The Young-Dees operation for the correction of retrograde ejaculation.

Retrograde ejaculation can be a significant problem when it interferes with fertility. Sympathomimetic drugs and sperm retrieval from the urine with insemination of the wife are the common methods of treatment. When these methods have not been successful we have used the Young-Dees type of bladder neck reconstruction to convert retrograde ejaculation into normal or antegrade ejaculation. The operation has been successful in 4 of 5 patients.

Adolescent↗