Vigorous prostatic massage: a simple method to retrieve spermatozoa for intracytoplasmic sperm injection in psychogenic anejaculation: case report.
A simple, non-invasive method to retrieve spermatozoa from patients with anejaculation is described. Three patients with psychogenic primary anejaculation were referred for intracytoplasmic sperm injection (ICSI). On the day of oocyte retrieval, vigorous prostatic massage was done. Examination of the expressed prostatic secretion revealed a sufficient number of motile spermatozoa in cases 1 and 3. In case 1, only one poor quality oocyte was obtained and ICSI was unsuccessful. Spermatozoa were cryopreserved for future use. In case 2, no spermatozoa were retrieved by prostatic massage. A testicular biopsy was performed to retrieve spermatozoa for ICSI. Unfortunately no pregnancy resulted. In case 3, retrieved spermatozoa were successfully used for ICSI, and 19 ova were injected. Fertilization occurred in 10 of these; seven were cryopreserved and three embryos were transferred. Ultrasound scan has confirmed a singleton pregnancy, which is ongoing. We conclude that vigorous prostatic massage could be an effective method of sperm retrieval for assisted conception in selected patients with anejaculation.