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Biomedical subjects

S J Silber

Publications and source records attributed to S J Silber.

At least 55 records · Page 3Linked to original sources
PubMed1990

Congenital absence of the vas deferens. The fertilizing capacity of human epididymal sperm.

BACKGROUND: Congenital absence of the vas deferens has been considered a virtually untreatable cause of male sterility. Furthermore, sperm that have not passed through at least the head of the epididymis have been thought to be incapable of causing pregnancy. We attempted to determine whether human sperm that had never passed through the epididymis could fertilize eggs in vitro and whether the technique could be used for men with congenital absence of the vas deferens. METHODS: Twenty-eight men with congenital absence of the vas deferens underwent microsurgical aspiration of sperm from the epididymis and vasa efferentia for attempted in vitro fertilization of their wives' oocytes, with subsequent transfer of embryos. Thirty-two treatment cycles were begun (four were repeat cycles). RESULTS: The most motile sperm were found in the proximal epididymis, at or near the vasa efferentia. Embryos were obtained for transfer in 21 cases (66 percent). Ninety-three embryos resulted from 352 mature oocytes (fertilization rate, 26 percent). Clinical pregnancy was achieved in 10 of the 32 treatment cycles (31 percent). Seven women delivered normal infants, and three miscarried. One of the seven live births was of twins. There were six girls and two boys. When fewer than 10 eggs were retrieved, no pregnancy occurred. When 10 or more eggs were retrieved (20 cases), the pregnancy rate was 50 percent. CONCLUSIONS: Sperm from the proximal caput epididymidis and even sperm from the vasa efferentia (which have never passed through the epididymis) can fertilize the human oocyte in vitro and result in pregnancy with live birth.

Adult↗
PubMed1990

Quantitative evaluation of spermatogenesis by testicular histology in men with congenital absence of the vas deferens undergoing epididymal sperm aspiration.

A quantitative histological evaluation of testicular biopsy in patients undergoing microsurgical epididymal sperm retrieval for in-vitro fertilization revealed no correlation between the quantity or quality of spermatozoa retrieved and the actual testicular sperm production. Poor retrieval of sperm was associated with blockage induced by secondary pressure damage in the rete testis collecting area.

Biopsy, Needle↗
PubMed1989

Role of epididymis in sperm maturation.

One hundred ninety patients with obstructive azoospermia caused by bilateral epididymal blockage have been followed up for four years or longer after undergoing "specific tubule" vasoepididymostomy. When anastomosis was required in the corpus epididymis, the "patency" rate was 78 percent, and the overall pregnancy rate was 56 percent. The pregnancy rate for "patent" cases was 72 percent, indicating that a high fertility rate can be obtained with sperm that have not transited the full length of corpus epididymis. By contrast, with vasoepididymostomy to the caput epididymis there was a 73 percent "patency" rate, but the overall pregnancy rate was only 31 percent. The pregnancy rate for "patent" cases was 43 percent. Sperm from the corpus epididymis have a higher rate of fertility than sperm from the caput epididymis, but sperm from proximal areas of the corpus have no less fertility than sperm from the distal corpus epididymis. The most remarkable observation is that in almost half the cases sperm that have never journeyed beyond the caput epididymis seem to be capable of causing pregnancy.

Anastomosis, Surgical↗
PubMed1989

Results of microsurgical vasoepididymostomy: role of epididymis in sperm maturation.

One-hundred-and-ninety patients with obstructive azoospermia caused by bilateral epididymal blockage have been followed for greater than or equal to 4 years after undergoing 'specific tubule' vasoepididymostomy. When anastomosis was required in the corpus epididymidis, the 'patency' rate was 78% and the overall pregnancy rate was 56%. The pregnancy rate for 'patent' cases was 72%, indicating that a high fertility rate can be obtained with spermatozoa that have not passed through the full length of corpus epididymidis. By contrast, with vasoepididymostomy to the caput epididymidis there was a 73% 'patency' rate, but the overall pregnancy rate was only 31%. The pregnancy rate for 'patent' cases was 43%. Spermatozoa from the corpus epididymidis have a higher rate of fertility than spermatozoa from the caput epididymidis, but spermatozoa from proximal areas of the corpus have no less fertility than spermatozoa from the distal corpus epididymidis. The most remarkable observation is that in almost half the cases, spermatozoa which have never journeyed beyond the caput epididymidis seem to be capable of causing pregnancy.

Epididymis↗
PubMed1989

Pregnancy after vasovasostomy for vasectomy reversal: a study of factors affecting long-term return of fertility in 282 patients followed for 10 years.

The aim of this study was to determine the eventual fertility of those patients following vasectomy reversal who have no pressure-induced secondary epididymal blockage. These patients underwent simple vasovasostomy because at the time of the reversal surgery there were sperm present in large numbers in the vas fluid. It was possible to obtain long-term follow-up on 326 early patients who underwent vasectomy reversal 8-10 years ago. Two hundred and eighty-two of those patients had sperm in the vas fluid. These patients were studied for pregnancy rate and post-operative semen parameters in relation to presence or absence of sperm in the vas fluid at the time of vasectomy reversal, duration of time since vasectomy, pre-operative serum antisperm antibody titers, the influence of varicocoele and quantitative evaluation of testicular biopsy. All of the 44 patients with no sperm in the vas fluid remained azoospermic following vasovasostomy. Of the 282 patients with sperm in the vas fluid, 228 (81%) eventually impregnated their wives. Twenty-four patients with sperm in the vas fluid (9%) were azoospermic and did not impregnate their wives. Of the 258 patients who had sperm patency, the pregnancy rate was 88%. The number of mature spermatids per tubule in the testis correlated closely with the post-operative sperm count in patent cases. Quantitative evaluation of the testicular biopsy revealed normal spermatogenesis, even in patients with azoospermia or severe oligospermia post-operatively. Technical failures were due to blockage either at the vasovasostomy site, or epididymal blockage unrecognized at the time of vasovasostomy.2+perm count had a minimal impact on the

Female↗
PubMed1989

Programming of ovarian stimulation with norethindrone acetate in IVF/GIFT cycles.

Twenty patients were given norethindrone acetate (NET) to program the initiation of controlled ovarian hyperstimulation and to coordinate follicular aspiration with surgery to obtain spermatozoa from the husband. Patients received NET, 10 mg/day orally, starting between days 2 and 4 of the cycle. The duration of NET therapy varied from 9 to 37 days. The mean time of onset of vaginal bleeding, after cessation of NET, was 2.9 +/- 0.7 days. Ovarian stimulation was carried out with a combination of a luteinizing hormone releasing hormone analog, follicle-stimulating hormone and human menopausal gonadotrophin. The day of human chorionic gonadotrophin (HCG) administration ranged from day 8 to day 15 of the cycle (10.1 +/- 1.7). On the day of HCG injection, the mean E2 level was 2188 +/- 1126. The mean number of follicles aspirated was 18.4 +/- 9.9 per cycle. The mean number of oocytes collected per cycle was 15.5 +/- 8.5. There was no correlation between duration of NET suppression and the number of days of gonadotrophin therapy needed to reach HCG administration. The large number of oocytes retrieved is probably related more with the fact that the patients represented a group with a purely male factor of infertility, than by the specific drug protocol utilized. Our results demonstrate that the ovarian response to gonadotrophin stimulation was not affected by NET administration. The main advantages of the use of this drug for cycle control are that its administration is oral, simple and inexpensive.

Adult↗
PubMed1989

The relationship of abnormal semen parameters to male fertility.

To what extent do standard semen parameters reflect male fertility? A review of many studies over the last 35 years relating pregnancy rate to sperm counts in 'fertile' and 'infertile' couples indicates that standard semen parameters, though much maligned of late, are useful in evaluating the degree of 'male factor' in an infertile couple. However, 'male factor' is quite compatible with fertility in a couple if the wife is very fertile. Oligoasthenozoospermia is, unfortunately, for the most part, an untreatable condition. Yet, vigorous treatment of the wife may still result in pregnancy despite very poor semen quality. Higher sperm counts in an infertile couple are associated with higher pregnancy rates. But in the majority of infertile couples in whom the sperm count is poor, female factors also exist that prevent conception. If the wife were very fertile, she would have become pregnant despite her husband's oligozoospermia, and they would never have seen a physician for infertility. Thus, pregnancy can be achieved with very low sperm counts either by treatment of the wife, IVF, GIFT or ZIFT procedures.

Female↗
PubMed1984

Microsurgery for vasectomy reversal and vasoepididymostomy.

Accurate microsurgical techniques developed by us have allowed a considerable improvement in success rate for vasectomy reversal, and a better understanding of the pathophysiology of obstruction. This has permitted us also to treat pathologic obstructive azoospermia more effectively.

Biopsy↗
PubMed1984

Impotence.

Explore the source record for details and available documents.

Ejaculation↗
PubMed1983

Simultaneous treatment of the wife in infertile couples with oligospermia.

Poor ovulation was found to be common in infertile couples with oligospermia. When the sperm count was less than 5 x 10(6)/ml, 33% of wives had poor ovulation. When the sperm count was between 5 x 10(6)/ml and 20 x 10(6)/ml, 78% of wives had poor ovulation. Improvement in sperm count was most likely to increase the chances of conception when the pretreatment sperm count was less than 5 x 10(6)/ml. Pregnancy in infertile couples with oligospermia cannot be related simply to treatment or improvement in the husband's oligospermia but can only be viewed in the context of the wife's fertility, which is quite frequently also impaired in infertile couples with male factor problems.

Clomiphene↗