Male Fertility Unit, Department of Obstetrics & Gnecology, Bikur Cholim Hospital, Strauss 5, Jerusalem 91004, Israel
1 To whom correspondence should be addressed. Email: spl113{at}netvision.net.il
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Abstract |
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Key words: anejaculation/electroejaculation/sperm quality
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Introduction |
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Previous studies demonstrated that electroejaculated sperm exhibited severe asthenozoospermia. This was the case in patients with spinal cord injuries (Chung et al., 1995) as well as those who suffered from psychogenic anejaculation (Hovav et al., 1996
). The asthenozoospermia in spinal cord-injured patients may be related to increased scrotal temperature, urinary infection, stasis of seminal fluid, neural effects on physiology of the testis and epididymis, sperm autoimmunity and external testicular pressure effects of the closed leg position (Chung et al., 1995
). The sperm quality of patients with psychogenic anejaculation is similar to that of patients with spinal cord injuries, despite the fact that the former patients do not have a neurological disorder and its complications (Hovav et al., 1996
).
In a previous study, we showed extreme variability in sperm parameters among different patients suffering from psychogenic anejaculation (Hovav et al., 1996). The aim of our present study was to establish the consistency of semen parameters in repeated electroejaculates from the same neurologically intact patient.
During the last 10 years, we performed multiple electroejaculations on 59 men who were neurologically intact. In the present study we compared the characteristics of the first and the second electroejaculates of these men.
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Materials and methods |
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The mean time interval between the first and the second ejaculations was 134.6±159 days (range 1654, median 89).
Electroejaculation procedure
In all, 108 procedures of electroejaculation, approved by the Institutional Review Board, were performed under general anaesthesia while the patients were placed in lateral decubitus as previously described (Hovav et al., 1996), with the use of the Seager Model 14 Electroejaculator (Dalzell Medical System, The Plains, VA, USA). Prior to electrostimulation, the bladder was flushed by Ham's F-10 medium (Sigma Chemical Co., St Louis, MO, USA) (pH 7.4) and 20 ml of medium was instilled for collection of retrograde-emitted sperm. Multiple electrical stimulations ranging from 5 to 20 V and lasting for
2 s were administered. The urethra was manually milked into a sterile container both during and upon completion of electrostimulation to obtain the maximum volume of antegrade semen. After electroejaculation, a bladder catheterization was routinely performed for collection of retrograde specimens.
Sperm analysis and preparation
The sperm obtained in the antegrade and retrograde ejaculates were processed by the discontinuous Percoll gradient as previously described (Van Der Zwalmen et al., 1991). The concentration and motility of the antegrade and retrograde portions of the electroejaculates were assessed using a Makler counting chamber according to published guidelines (World Health Organization, 1993
).
Statistical analysis
Statistical analysis was performed using the Wilcoxon rank test, appropriate for pair-matched observations. The probability values reported are exact and not asymptotic. P<0.05 was considered significant. The analysis was performed using Stat Xact 4.0 (Cytel Software Corporation, Cambridge, MA, USA). The data presented as mean ± SEM.
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Results |
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Discussion |
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The sperm concentration and motility were unsatisfactory in both the antegrade and retrograde fractions in the first and the in the second procedures. These findings are consistent with our previous study (Hovav et al., 1996).
The only significant difference shown between the first and the second testing was in the antegrade volume when the time interval was <3 months. Because spontaneous semen emission is very rare in these men there is a possibility of stasis of the seminal fluid. Therefore, in the first electroejaculation the volume may be greater than in the subsequent short-interval ones.
During emission and ejaculation in normal men, the internal urinary sphincter closes under the influence of sympathetic innervation from the T10L2 spinal cord segments, causing semen to be expelled from the penis. In men with spinal cord injury, whose innervation may be disrupted, the retrograde ejaculation after electroejaculation is related to their neuropathology. Retrograde ejaculation was ruled out in all our patients who were neurologically intact. However, most of them did have retrograde ejaculation with electroejaculation. These findings suggest that the appearance of a retrograde fraction with electroejaculation, in men with spinal cord injury, may be due to methodological issues rather than due to the neuropathology.
In the electroejaculate from men with spinal cord injury, sperm motility is higher in the antegrade versus the retrograde fraction. However, the concentration is usually higher in the retrograde specimen (Brackett and Lynne, 2000). In our study, the count and the total sperm motility were higher in the antegrade versus the retrograde fraction.
The quality of the electroejaculate obtained from men suffering from spinal cord injury is low. Some investigators have reported improvement in the semen parameters after repeated electroejaculations (Wang et al., 1992; Witt et al., 1992
; Ohl, 1993
; Mallidis et al., 2000
), but others have not observed this association (Denil et al., 1992
; Chung et al., 1997
; Brackett et al., 1998
; Heruti et al., 2001
). Recently, a prospective, randomized, controlled study suggested that multiple electroejaculations have a positive effect on semen parameters in men with spinal cord injury. The author suggests that the repeated procedures diminish the negative effect related to sperm and sex organ fluid stasis (Giulini et al., 2004
). In the current study we found no improvement in the sperm parameters in the second electroejaculation, even in the 30 patients in which the interval between the procedures was <3 months. This may be because these men have nocturnal emissions and therefore they do not suffer from seminal fluid stasis.
Our study helps to establish the consistency of semen parameters in the first versus second electroejaculates of neurologically intact men.
We conclude that repeated electroejaculations for the purpose of improving the sperm quality may not be justified in anejaculatory, neurologically intact men.
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References |
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Submitted on February 13, 2005; resubmitted on March 23, 2005; accepted on April 7, 2005.
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