1 Department of Obstetrics and Gynecology, Bikur Cholim Hospital and 2 IVF Unit, Hadassah Mount Scopus Hospital, Jerusalem, Israel
![]() |
Abstract |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
Key words: anejaculation/cryopreservation/electroejaculation/fertilization rates/ICSI
![]() |
Introduction |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
Electroejaculation has been successfully used for sperm procurement in anejaculatory men desiring fertility. However, electroejaculation may alter semen quality (Brackett and Lynne, 2000). Electroejaculates from men with spinal cord injury often exhibit low sperm motility, decreased viability, reduced longevity of motility, poor cervical mucus penetration and compromised hamster oocyte penetration (Chung et al., 1995
).
In a previous study, we demonstrated that the electroejaculates obtained from men with psychogenic anejaculation also show poor motility (Hovav et al., 1996). Despite these deficiencies, two studies have shown reliable cryopreservation characteristics of semen produced by electroejaculation (Buch and Zorn, 1993
; Pardon et al., 1994
), but there are no reports of clinical use of cryopreserved electroejaculates from men with psychogenic anejaculation.
In this study, we evaluated fertilization rates when performing ICSI in combination with cryopreserved electroejaculates from men with psychogenic anejaculation. The first pregnancies with these sperm are reported.
![]() |
Materials and methods |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
Fresh sperm were used in 29 cycles (17 couples; group I). Cryopreserved sperm were used in 10 cycles (eight couples; group II). The age of the men (mean ± SD) was 31.9 ± 8.6 years (range: 2450). The mean age of the women in group I and II was 29.4 ± 6.9 (range: 2145) and 28.7 ± 7.3 years (range: 2245) respectively.
The study was approved by the Institutional Review Boards in Bikur Cholim and Hadassah Hospitals.
Electroejaculation, sperm preparation and cryopreservation
A total of 37 procedures of electroejaculation 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). The procedures were done at Bikur Cholim Hospital without any complications. Sperm procurement was successful in all patients. The antegrade and retrograde portions of the ejaculate were assessed for sperm concentration and motility according to the World Health Organization guidelines for semen analysis (World Health Organization, 1999
).
When fresh sperm was used, both antegrade and retrograde samples were prepared for ICSI by washing twice (1800 g, 5min) in medium IVF-50. The remaining sperm were frozen for further treatment.
For sperm cryopreservation, the antegrade sample was diluted 1:1 (v/v) in TEST-YOLK buffer with glycerol (Irvine Scientific, Santa Ana, CA, USA) and the retrograde ejaculate was concentrated by 5 min centrifugation at 1800 g followed by suspension of the pellet in TEST-YOLK buffer. Aliquots of 0.10.2 ml were frozen in liquid nitrogen as previously described (Hovav et al., 1996).
Ovarian stimulation, ICSI and embryo transfer
Controlled ovarian stimulation was obtained by administration of GnRH agonist (Decapeptyl CR; Ferring, Malmo, Sweden) in the midluteal phase with subsequent administration of FSH (Metrodin; Teva, Kfar-Sava, Israel).
Follicular development and the concentrations of estradiol and progesterone in blood were monitored. HCG (10 000 IU; Teva) was injected to achieve oocyte maturity; 3638 h thereafter, transvaginal oocyte retrieval was performed. ICSI was carried out essentially as previously described (Palermo et al., 1995). Two to four good quality embryos were transferred into the uterine cavity 4872 h after ICSI was performed.
Clinical pregnancy was established when a positive fetal heartbeat was determined by sonography.
Statistical analysis
Statistical analysis was performed by using the 2 test.
![]() |
Results |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
After thawing the ejaculates, motile sperm with moderate forward progression were found in nine out of 10 cycles (group II). In this group, of the 94 oocytes that were injected, 47 (50%) were fertilized normally. When frozenthawed motile sperm were injected, the fertilization rate was 47/82 (57%) (Table I). There were no statistical differences in fertilization rates between the two groups. A total of 21 embryos were transferred and four pregnancies were achieved (40% per cycle). Two of them were full term (one following the transfer of frozenthawed embryos). One is an ongoing pregnancy, and one resulted in a premature delivery at 25 weeks. Due to the low number of pregnancies, no statistical comparisons were made between the two groups.
|
![]() |
Discussion |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
In the majority of our patients, the problem of psychogenic anejaculation seems to be related to their strict orthodox education, in which sex is considered abhorrent and taboo. Therefore, any indulgence in the subject was absolutely forbidden.
Previous studies, in men suffering from spinal cord injuries, showed favourable cryopreservation (post-thaw motility was >33% of original pre-freeze motility) in five of 16 (31%) electroejaculates. The average original motility preserved was 21% as compared with ~50% motility preservation in control groups (Buch and Zorn, 1993).
Pardon et al. reported no differences in mean percentage drop in post-thaw motility between electroejaculates and the control group (Pardon et al., 1994).
In our study, the pregnancy rate with fresh electroejaculate (group I) was only 10.5% per cycle. Schalte et al. reported similar results in ICSI with sperm obtained by electroejaculation from men with spinal cord injury (pregnancy rate of 15% with electroejaculation compared with 39% using normal ejaculated sperm) (Schalte et al., 2000).
These findings suggest that electroejaculation may affect sperm function. The higher pregnancy rate observed when sperm were cryopreserved after electroejaculation suggests the possibility that the process of freezingthawing constitutes a form of selection. Sperm that retain their motility after thawing may have been less affected by the electroejaculation procedure. Obviously, this speculation should be validated by further experience with frozen electroejaculates.
Our results indicate that the fertility potential of cryopreserved electroejaculated sperm is similar to that of freshly obtained electroejaculated sperm. We therefore suggest that with the use of frozenthawed sperm samples, the frequency of transrectal electroejaculation procedures may be lowered.
We conclude that since electroejaculation in patients with psychogenic anejaculation requires general anaesthesia and might be associated with side-effects as well as tremendous emotional stress, the use of cryopreserved electroejaculates may lessen the risks and burden of the patients and provide reasonable chances of pregnancy.
At present, not many physicians perform electroejaculation. The possibility of performing electroejaculation electively, without being confined to the timing of oocyte retrieval and cryopreserving the ejaculate, could simplify the procedure and make the co-operation between units easier.
![]() |
Notes |
---|
Submitted on July 3, 2001; resubmitted on September 13, 2001
![]() |
References |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
Buch, J.P. and Zorn, B.H. (1993) Evaluation and treatment of infertility in spinal cord injured men through rectal probe electroejaculation. J. Urol., 149, 13501354.[ISI][Medline]
Chung, P.H., Yeko, T.R., Mayer, J.C., Sanford, E.J. and Maroulis, G.B. (1995) Assisted fertility using electroejaculation in men with spinal cord injurya review of the literature. Fertil. Steril., 64, 19.[ISI][Medline]
Hovav, Y., Shotland, Y., Yaffe, H. and Almagor, M. (1996) Electroejaculation and assisted fertility in men with psychogenic anejaculation. Fertil. Steril., 66, 620623.[ISI][Medline]
Palermo, G.D., Cohen, J., Alikani, M., Adler, A. and Rosenwaks, Z. (1995) Intracytoplasmic sperm injection: a novel treatment for all forms of male factor infertility. Fertil. Steril., 63, 12311240.[ISI][Medline]
Pardon, O.F., Brackett, N.L., Weizman, M.S. and Lynne, C.M. (1994) Semen of spinal cord injured men freezes reliably. J. Androl., 15, 266269.
Schalte, E.C., Orejuela, F.J., Lipshultz, L.I., Kim, E.D. and Lamb, D.J. (2000) Treatment of infertility due to anejaculation in the male with electroejaculation and intracytoplasmic sperm injection. J. Urol., 163, 17171720.[ISI][Medline]
World Health Organization (1999) Laboratory Manual for the Examination of Human Semen and Semencervical Mucus Interaction, 4th edn, Cambridge University Press, New York.
accepted on October 24, 2001.