PubMed · 12166222
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Hiroshi Hara. 2002. [Painful ejaculation].. https://pubmed.ncbi.nlm.nih.gov/12166222/
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OBJECTIVE: To assess the efficacy of intracytoplasmic sperm injection (ICSI) in term of pregnancy rate with immotile spermatozoa from ejaculate, epididymis and testis. STUDY DESIGN: A retrospective study was conducted between January 1998 and March 2001. We performed intracytoplasmic sperm injection with immotile spermatozoa, in 160 couples during 172 cycles. RESULTS: The birth rate per cycle was 38.4% in immotile spermatozoa from ejaculate, 35.4% from testis and 38.7% from epididymis. CONCLUSION: This retrospective analysis shows that immotile spermatozoa retrieved from epididymis or testicle gives similar fertilization and pregnancies rates as immotile spermatozoa from ejaculate.
STUDY DESIGN: In this multicenter, prospective, 2-year study, 146 male patients underwent a single-level anterior lumbar interbody fusion with a tapered threaded titanium fusion device. All the patients were advised before surgery of the risk for retrograde ejaculation. After surgery, any case of retrograde ejaculation was recorded as an adverse event, and the patient was observed up for the remainder of the study. OBJECTIVE: To determine the incidence of retrograde ejaculation in male patients treated for single-level degenerative lumbar disc disease at L4-L5 or L5-S1 with a stand-alone anterior interbody fusion using tapered, threaded titanium fusion cages. SUMMARY OF BACKGROUND DATA: The incidence of retrograde ejaculation in men after anterior lumbosacral spinal surgery has been reported to range from 0.42% to 5.9%. Various risk factors that increase the chance of retrograde ejaculation have been proposed. METHODS: In this prospective study, 146 male patients underwent an open surgical exposure of the lumbosacral junction and a single-level interbody fusion at either L4-L5 or L5-S1. Assessment of a patient's clinical outcome was based on written questionnaires at 6 weeks and then 3, 6, 12, and 24 months after surgery. Patients were questioned about adverse events at each of these assessments, and any case of retrograde ejaculation was recorded and followed. RESULTS: Retrograde ejaculation developed in 6 of the 146 men after open anterior lumbar interbody fusion surgery. Two cases (1.7%; 2/116) involved patients who underwent a retroperitoneal surgical exposure. Four cases (13.3%; 4/30) involved patients who had a transperitoneal surgical exposure. This difference is statistically significant according to Fisher's exact test (P = 0.017). At 12 months after surgery, 2 patients had resolution of their symptoms: 1 in the retroperitoneal approach group and 1 in the transperitoneal group. At the final 2-year follow-up, no changes in symptoms were reported. One patient in the retroperitoneal approach group (0.86%) and three patients in the transperitoneal group (10%) reported permanent retrograde ejaculation (P = 0.027). CONCLUSIONS: A transperitoneal approach to the lumbar spine at L4-L5 and L5-S1 has a 10 times greater chance of causing retrograde ejaculation in men than a retroperitoneal approach.
OBJECTIVE: To evaluate the influence of morphology of individual spermatozoa on fertilization and pregnancy outcome. DESIGN: Retrospective analysis. SETTING: An IVF center in an institutional research environment. PATIENT(S): Fertilization and embryo quality according to individual sperm morphology were analyzed in 662 consecutive ICSI cycles. Pregnancy outcome was evaluated for these cycles and an additional 1005 consecutive ICSI cycles. INTERVENTION(S): ICSI was performed using sperm cells of ejaculated, epididymal, or testicular origin. Observation through an inverted microscope was used to prospectively classify injected sperm cells as normal or morphologically abnormal. MAIN OUTCOME MEASURE(S): Oocyte fertilization, embryo morphology, and pregnancy outcome of unmixed embryo transfers. RESULT(S): Injection of morphologically abnormal spermatozoa (irrespective of origin) resulted in a lower fertilization rate (60.7%) than did injection of morphologically normal spermatozoa (71.7%). Embryo cleavage quality did not differ between groups. Higher pregnancy and implantation rates were obtained in patients with normal sperm morphology (36.7% and 18.7%, respectively) than in those with abnormal sperm morphology (20.2% and 9.6%). CONCLUSION(S): Individual sperm morphology assessed at the moment of ICSI correlated well with fertilization outcome but did not affect embryo development. The implantation rate was lower when only embryos resulting from injection of an abnormal spermatozoon were available.