Male Fertility Unit, Department of Obstetrics & Gnecology, Bikur Cholim Hospital, Strauss 5, Jerusalem 91004, Israel
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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 epidiymis, sperm autoimmunity and external testicular pressure effects of the `closed-leg' position (Chung et al., 1995). It has recently been suggested that abnormal seminal plasma contributes to asthenozoospermia in men with spinal cord injuries (Brackett et al., 2000
). 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. Therefore, electroejaculation may be associated with significant effects detrimental to sperm motility (Hovav et al., 1996
).
In psychogenic anejaculatory men, the aetiology of the asthenozoospermia remains uncertain. It may be related to primary low-grade motility of sperm or to detrimental effects of the actual procedure of electroejaculation.
During the last 5 years, we performed electroejaculation on nine men who later succeeded in ejaculating spontaneously. In the present study, we compared the characteristics of the electroejaculates with those of the spontaneous ejaculates in these patients.
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Materials and methods |
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Patient 9 was a single, 22 year old man with non-Hodgkin's lymphoma. Before chemotherapy was initiated, he managed once to produce sperm for cryopreservation by masturbation. Since his additional attempts during the following 7 days had failed even with penile vibratory stimulation, he agreed to undergo treatment by electroejaculation.
Electroejaculation and semen analysis
In all, 14 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). Sperm procurement was successful in all patients without any complications.
The spontaneous ejaculates were produced during coitus using a condom without spermicide and were assessed within 40 min. Patient 9 provided semen by masturbation into a sterile cup.
The concentration and motility of the antegrade portions of the electroejaculates and of the natural ejaculates were assessed using a Makler counting chamber according to published guidelines (World Health Organization, 1993).
Sperm motility was assessed as the percentage of sperm showing progressive motility, while the quality of motility was assessed as being good if forward movement with progression was observed, moderate if definite forward progression was seen and poor if only weak or sluggish progression was present.
Statistical analysis
Statistical analysis was performed using the Wilcoxon rank test, appropriate for pair-matched observations. The statistical significances 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). When more than one semen sample (either spontaneous or by electrostimulation) was provided, the ejaculates obtained in the shortest time interval were compared.
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Results |
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Discussion: |
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There is conflicting evidence about damaging effects of electroejaculation on sperm motility with some studies showing an effect (Linsenmeyer et al., 1989; Rajasekaran et al., 1994
; Sikka et al., 1994
) while others showing none (Ohl et al., 1994
).
Brackett et al. found that in 10 men with spinal cord injury sperm motility was significantly higher when sperm were obtained by PVS as compared with electroejaculation (Brackett et al., 1997). Sperm concentration however, was similar in the two methods.
Ohl et al. showed no difference in the concentration of sperm obtained with PVS versus electroejaculation in 11 men suffering from spinal cord injury. However, the motility was lower in the electroejaculates (10.7 versus 26%) (Ohl et al., 1997).
The favourable results with PVS may be attributed to the fact that ejaculation by PVS is considered more physiological than electroejaculation. Thus, spontaneous ejaculation should be better than electroejaculation. Indeed, it has been demonstrated that in men suffering from spinal cord injury the quality of semen obtained using masturbation and PVS was better than that collected using electroejaculation (Brackett and Lynne, 2000).
To the best of our knowledge, our study is the first to compare the characteristics of the electroejaculates and spontaneous ejaculates in neurologically intact men. A better study would be to perform electroejaculation on a larger group of normal men and to compare the electroejaculate with the spontaneous ejaculates obtained during the same period. However, for obvious reasons such a study cannot be conducted. Despite these limitations our study showed no statistical difference between the two methods.
In a previous study, we found low sperm motility in electroejaculates obtained from men suffering from psychogenic anejaculation (Hovav et al., 1996). It was not known if the patients actually suffered from asthenozoospermia or if the electroejaculation procedure lowered otherwise normal sperm motility of these patients. The present study indicates the first option. If so, the cause for the low sperm motility produced by these patients needs to be explained.
It seems reasonable to assume that, in these patients due to their rare ejaculation by nocturnal emission, the prolonged storage of sperm results in a gradual loss of their motility. Indeed, in a previous study we found that sperm with very low motility can be obtained by prostatic massage in men with psychogenic anejaculation (Hovav et al., 2000).
Because abnormal seminal plasma may influence sperm motility in men with spinal cord injuries (Brackett et al., 2000), it would be of interest to compare the compositions of seminal plasma obtained be electroejaculation or spontaneous ejaculation in men suffering from psychogenic anejaculation.
In summary we have shown that in nine men suffering from psychogenic anejaculation, the concentration and the motility of sperm obtained by electroejaculation were not significantly different from sperm obtained naturally.
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Notes |
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References |
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Brackett, N.L., Padron, O.F. and Lynne, C.M. (1997) Semen quality of spinal cord injured men is better when obtained by vibratory stimulation versus electroejaculation. J. Urol., 157, 151157.[ISI][Medline]
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World Health Organization (1993) Laboratory Manual for the Examination of Human Semen and SpermCervical Mucus Interaction, 3rd edn. Cambridge University Press, New York.
Submitted on April 18, 2002; resubmitted on August 1, 2002; accepted on August 15, 2002.