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Proacrosin has been isolated from human ejaculated spermatozoa and constitutes at least 90% of the total acrosin present. The total amount of acrosin in milli-international units per million spermatozoa was between 4.4 and 8.9, with a mean of 6.5. This is the first report of the demonstration of proacrosin and the quantitation of total acrosin in human spermatozoa.
Our data indicate that an appropriate therapy for the infertility associated with retrograde ejaculation is isolation of sperm from voided urine after orgasm, plus IUI. This technique is simple and can be performed in the physician's office, in contrast to more complex techniques such as GIFT or in vitro fertilization.
OBJECTIVE: To determine if sera of some women have antibodies against capacitated but not freshly ejaculated sperm. DESIGN: The sera of 66 women undergoing in vitro fertilization (IVF) were tested for sperm antibodies after 1 hour and 18 hours of sperm incubation in the maternal sera. Subsequently, 5 sera were tested with capacitated versus noncapacitated sperm cells. SETTING: The study was carried out in a university hospital department. PATIENTS, PARTICIPANTS: The patients were 66 consecutive couples undergoing IVF. INTERVENTIONS: Sera and semen that were taken for routine tests as part of the IVF procedures were used. MAIN OUTCOME MEASURES: A case with IVF failure associated with late appearance of sperm antibodies prompted us to study the detection of sperm antibodies after 1 hour and 18 hours incubation. RESULTS: Of 37 cases negative for sperm antibodies after 1 hour incubation, 7 demonstrated high levels of antibodies after 18 hours incubation. In 21 of 23 cases with low or intermediate levels of antibodies after 1 hour incubation, significantly higher levels (P less than 0.05) of antibodies were found after 18 hours. Different and higher levels of sperm antibodies were observed in five sera after incubation of 1 hour with capacitated sperm as compared with noncapacitated controls. CONCLUSIONS: Major antigenic differences may exist between capacitated and noncapacitated sperm. In some women sperm antibodies are reactive against capacitated sperm only. This has no certain clinical significance but may explain certain cases of IVF failure, unexplained infertility, and part of the variation in sperm antibodies testing methods.
Seven infertile patients with retrograde ejaculation, in which spermatozoa could be recuperated from the postejaculation urine, were admitted to a sperm recuperation and cervical insemination program. A noninvasive method for sperm recuperation based on urine alcalinization and serial controls to time masturbation has been used. Insemination has been timed according to BBT charts and cervical mucus characteristics. Pregnancy has been obtained in the seven couples after one to eight treatment cycles.
OBJECTIVE: To assess whether sperm recovered from postejaculatory urine and cryopreserved can be used successfully for intracytoplasmic sperm injection (ICSI). DESIGN: Case report. SETTING: Laboratory of Developmental and Reproductive Biology, University Hospital. PATIENT(S): A couple with male infertility resulting from complete retrograde ejaculation. INTERVENTION(S): Freezing of sperm recovered from urine and subsequent use for ICSI. MAIN OUTCOME MEASURE(S): Survival, maintenance of fertilization, and pregnancy potential of sperm recovered from urine and cryopreserved. RESULT(S): On thawing, the sperm were still alive (32% viability) and very slightly motile (2% sluggish motility). Of 16 oocytes injected, 10 (62.5%) produced normal, cleaving embryos. A twin pregnancy with the birth of two healthy infant girls was achieved after the transfer of three embryos. CONCLUSION(S): The birth of normal, healthy female infants after ICSI with sperm recovered from postejaculatory urine and then cryopreserved demonstrates the usefulness of freezing such sperm even if motility is very low, to avoid surgery in the patient.
PURPOSE: Premature ejaculation/rapid ejaculation is a common but incompletely understood male sexual dysfunction. The purposes of this review are to 1) raise awareness of the prevalence and characteristics of PE/RE, its impact on the male and his partner, and the lack of approved medications indicated for its treatment, 2) encourage dialogue about PE/RE between physicians and patients, and 3) stimulate the development of appropriate new therapies. MATERIALS AND METHODS: A MEDLINE search was performed to retrieve articles relating to PE/RE pathophysiology, etiology, impact, diagnosis and treatment. Sexual medicine journals not indexed in MEDLINE, sexual medicine texts and congress abstracts were also reviewed. RESULTS: No universally accepted definition, licensed treatment, validated screening instrument or diagnostic criteria have been established for PE/RE, and its pathophysiology and etiology are incompletely understood. Additional barriers are the reluctance of patients and physicians to talk about PE/RE and the lack of knowledge regarding available treatments. Current pharmacological treatments include off label uses of antidepressants, topical anesthetics or phosphodiesterase-5 inhibitors. All are associated with drawbacks that limit their efficacy. Psychological counseling and behavioral therapy have a valuable role, although resources for this modality are limited. CONCLUSIONS: Prevalence rates of 20% to 30% and negative effects on the quality of life of men and their partners illustrate the need for improved, standardized methods of PE/RE diagnosis, assessment and treatment. Medications indicated specifically for PE/RE and effective on an as needed basis are required. Behavioral therapies should emphasize pleasure, arousal, control, confidence and satisfaction, and they may have the best success when coupled with pharmacological approaches.
We report a case of retrograde ejaculation due to an unusual prostatic urethral mass. The resected tissue was histologically indistinguishable from corpus spongiosum, and due to its location it was diagnosed as heterotopic erectile tissue. The embryological origin of this lesion is discussed.
To address the consistent finding of asthenospermia in spinal cord injured men we compared the biochemical constituents of antegrade fractions of electroejaculates of 6 such patients with the manual ejaculates of 6 volunteers. Semen samples in each group were analyzed for 19 biochemical parameters, pH and osmolality. Organic components included triglycerides, glucose, fructose, uric acid, creatinine, urea, total protein, albumin and cholesterol. Metabolic enzymes, including glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase, lactate dehydrogenase and alkaline phosphatase, were measured. Inorganic constituents included chloride, sodium, potassium, zinc and phosphorous. Although not significant, higher levels of blood urea nitrogen and creatinine were demonstrated in most electroejaculates suggesting urinary contamination of the antegrade specimens. In electroejaculates significantly lower levels (p less than 0.05) of fructose, albumin, GOT and alkaline phosphatase as well as significantly higher levels (p less than 0.05) of chloride were noted. No significant difference in osmolality or pH was found. Moreover, in the electroejaculates the levels of glucose, uric acid and all inorganic constituents approached their corresponding levels in serum. We conclude that biochemical abnormalities of the seminal plasma may contribute to seminal dysfunction of spinal cord injured men and may result from neurological injury to the accessory sex glands or from the electroejaculation procedure itself.
The organization of virtually all basic survival mechanisms in the central nervous system (CNS) is within the most central regions of the mesencephalon and the rostrally adjoining diencephalon; in particular, the mesencephalic periaqueductal gray (PAG) and hypothalamus. The PAG sends specific pathways to the caudal brainstem where neurons are located that, in turn, control nociception, blood pressure, heart rate, and micturition. Via projections to the nucleus retroambiguus (NRA) in the most caudal part of the medulla, the PAG controls the intra-abdominal pressure associated with vocalization, vomiting, and parturition. In cats, the PAG also controls sexual posture via NRA projections to motoneurons in the lumbosacral cord. These NRA-lumbosacral motoneuronal pathways are almost nine times stronger in the estrous vs. non-estrous female cat. While neuronal activity in specific CNS pathways is now known to control sexual behavior in the cat, how is it organized in the human? PET-scan results on human ejaculation have revealed that the meso-diencephalic transition zone is particularly and strongly activated. This region includes the so-called ventral tegmental area that is also known as a "reward area." For example, it is also activated during a heroin rush. Other strongly activated structures during sexual activity include the cerebellum and lateral part of the corpus striatum. At the level of the cerebral cortex, areas in the prefrontal and parietal cortex are also activated, but exclusively on the right side. Further study of these structures should certainly lead to better insight into human sexual behavior and provide the possibility to improve sexual activity in those who suffer from problems in this area.
Cutaneous vibratory stimulation and rectal probe electroejaculation are highly successful methods of obtaining semen in the anejaculate patient. We report a case in which spermatozoa were retrieved in a brain dead man by artificially stimulated ejaculation. The specimen was cryopreserved to be used at a later date in combination with assisted reproductive techniques.
The purpose of this study was to assess the sperm quality of fresh ejaculated boar semen stored under different temperatures for up to 48 h in order to use the fresh semen efficiently. Spermatozoa were evaluated by 4 methods: Using trypan blue staining, the viability of spermatozoa stored at 39, 20, 15 and 4 degrees C for 48 h were 1.6, 46.9, 42.0 and 31.0%, respectively. Employing the hypoosmotic swelling test (HOST) showed 1.7%(39 degrees C), 28.7%(20 degrees C), 24.1%(15 degrees C), and 20.1%(4 degrees C) coiled-tail spermatozoa following 48 h storage. With Coomassie blue staining, the rates of acrosome-intact spermatozoa stored for 48 h were 4.5%(39 degrees C), 35.3%(20 degrees C), 55.7%(15 degrees C) and 22.8%(4 degrees C). Using fluorescein isothiocyanate-peanut agglutinin (FITC-PNA), the percentages of acrosome-intact spermatozoa stored for 48 h were 4.3%(39 degrees C), 43.2%(20 degrees C), 17.3%(15 degrees C) and 14.8%(4 degrees C), respectively. The cytoplasmic droplets were found in 18.66% of the spermatozoa in fresh semen and were gradually shed during storage. The results of these 4 methods were highly correlated and could be used to characterized sperm-cell quality effectively. These findings indicated that both membrane integrity and viability of spermatozoa could be preserved well during in vitro storage at 20 degrees C and 15 degrees C for 24 to 48 h.
PSA remains an immensely valuable tool in the diagnosis of prostate adenocarcinoma. Factors such as prostatitis, urinary retention, ejaculation, and inpatient versus outpatient measurement, however, may have a profound effect on the serum PSA concentration. Furthermore, prostate biopsy and TURP result in an increase in the serum PSA value that resolves in 4 to 6 weeks. It is imperative that these factors be taken into account to interpret serum PSA values, to optimize the diagnostic utility of the PSA test.
The presence of mRNAs in human ejaculate spermatozoa is well established, yet little is known of the representation or function of these transcripts. To address these issues, the complexity of spermatozoal RNA was examined. As expected, testis-expressed mRNAs were detected by RT-PCR in mature human spermatozoa. Interestingly, when a testis cDNA library was probed with total spermatozoal RNA, less than 2% of plaques gave a strong hybridization signal, suggesting a rather unique sperm-derived population. To further define the sequence distribution, 18 strongly hybridizing clones were selected at random for end-sequence analysis. Twelve matched unique sequences in the EST, STS and NR databases, whereas five showed no similarity to any of the sequences in the databases. In addition, one clone belonged to the SINE repetitive element family. As demonstrated by sequencing randomly primed cloned inserts, short (SINE/MER) or long (LINE/ORF2) interspersed repeat-like sequences are also contained as part of the spermatozoal RNA fraction. It is now evident that human spermatozoa contain a rich repertoire of both known and unknown protein-encoding and non-coding RNAs. This provides a unique opportunity to identify and investigate the many genes responsible for the structure and function/dysfunction of the male gamete using spermatozoal RNA as the template.
This study presents a case of intracytoplasmic sperm injection (ICSI) with ejaculated immotile spermatozoa from a patient with immotile cilia syndrome. Semen analysis of the patient suffering from immotile cilia syndrome revealed an extreme oligoasthenoteratozoospermia (OAT: count <1.4 x 10(6)/ml, 0% motility and 3% normal morphology). Electron microscopy of sperm flagella showed the absence of inner and outer dynein arms. During the ICSI cycle, the hypo-osmotic swelling test (HOS) was used for the identification of viable spermatozoa in the pool of immotile spermatozoa for ICSI. A normal fertilization rate was found in eight out of the 12 oocytes. A first fresh double embryo transfer resulted in a late miscarriage at 21 weeks. A second healthy singleton pregnancy occurred after transfer of two frozen-thawed embryos from the same ICSI procedure. Although only one successful ICSI case of the immotile cilia syndrome combined with HOS is described here, HOS might be a simple but valuable tool to obtain normal fertilization and pregnancy for patients suffering from immotile spermatozoa.
The activity of exoglycosidases in extracts from freshly ejaculated boar and bull spermatozoa with 0.2% Brij-35/2% acetic acid was measured. The results show that beta-N-acetylhexosaminidase, beta-galactosidase and alpha-mannosidase are the major glycosidases; much higher levels of activity were found in boar spermatozoa than in bull spermatozoa. When compared on a per spermatozoon basis, the ratios of the activities of beta-N-acetylhexosaminidase, beta-galactosidase and alpha-mannosidase in boar spermatozoon relative to those in bull spermatozoon were approximately 13000:1, 1700:1 and 400:1, respectively. Liberation of these glycosidases from bull spermatozoa by treatment with phosphatidylinositol-specific phospholipase C (PI-PLC) was low, in contrast to liberation of alpha-mannosidase from boar spermatozoa previously found by the same means. The possibility that the exoglycosidases present in large amounts in boar spermatozoa play a role in the process of binding to the zona pellucida glycoprotein of the egg is discussed.
Researchers investigating premature ejaculation (PE) have employed widely diverse definitions of it, thereby limiting progress in the field. This study summarizes available research on PE, notes patterns that emerge from these studies, compares patterns across several types of studies, and suggests a common model for defining PE groups to guide future research. We surveyed two bibliographic databases, identifying 45 studies employing a definition or description of a PE group. From these, we extracted a range of information, including descriptions of the participants, recruitment procedures, if PE subtypes were identified, operational criteria for PE classification, relationship and partner information, and additional inclusion/exclusion criteria. Over 50% of studies reported no criteria, or relied on simple self-identification by participants to establish the PE group. Quantifiable behavioral criteria were used in 49% of the studies, with ejaculatory latency reported most frequently. This measure was also used as a criterion more frequently in studies focusing on assessment of sexual response, whereas the number of penile thrusts was used more frequently in studies prior to 1989. Partner information was often included but seldom used as part of the assessment procedure. Progress on research and treatment of PE will continue to be limited by the absence of commonly accepted criteria for PE group membership and by a lack of identification of relevant PE subtypes and etiologies. This paper suggests a flowchart, based on data and a rational analysis of 40 years of research, for characterizing PE in ways that could assist the development of the field.
The enforced interval of copulation (EIC) consists of the artificial prolongation of the interintromission interval, induces a reduction in the number of intromissions preceding ejaculation, and is accompanied by an anxiety like behavioral repertoire. The administration of the benzodiazepine anxiolytics diazepam, chlordiazepoxide, flurazepam, and flunitrazepam produced a dose-dependent inhibition of the EIC effect with a concomitant increase in mounting. These actions were blocked by the central benzodiazepine antagonist Ro 15-1788. The anxiogenic agent beta-carboline Zk 39106 had no effect. Treatment with pentobarbital also produced a blockade of the reduction in the number of intromissions during EIC, whereas muscimol and bicuculline lacked this effect. The serotonergic anxiolytic buspirone reversed the facilitatory action induced by EIC; however, two putative serotonergic antianxiety agents, 8-OH-DPAT and ipsapirone, did not modify or potentiate it, respectively. Finally, the nonanxiolytic serotonergic compounds 5-hydroxytryptophan and TFMPP drastically increased the number of mounts but did not antagonize the reduction of intromissions produced by EIC. These results suggest that an increase in the anxiety levels may be responsible for the excitatory action of EIC on sexual behavior.
A 28 year old male sustained a cervical spinal cord injury (C5, complete) from a traffic accident and was impotent. He started intracavernous injection therapy, by his partner, of papaverine hydrochloride for impotence, restoring ejaculation. His partner had a successful pregnancy after normal sexual intercourse, and delivered a mature female child weighing 3330 g. To our knowledge this is a rare case of a patient with a complete spinal cord injury fathering a child by the above technique.