Retrograde ejaculation: a systematic approach to non-invasive recovery of spermatozoa from post-ejaculatory urine for artificial insemination

Retrograde ejaculation is an uncommon but treatable form of male infertility. Successful recovery of live spermatozoa from the post-ejaculatory urine for artificial insemination is dependent on careful regulation of pH and osmolarity of the urine into which ejaculation takes place, and separation of the motile spermatozoa from the debris and cells which are found in these samples. Three pregnancies established by artificial insemination of spermatozoa recovered by noninvasive means from the bladders of men suffering from retrograde ejaculation are described. The techniques for preparing the urine for spermatozoal survival, and for removal of cells and debris by sedimentation or buoyant density centrifugation are discussed.     

A new sperm collection method for treatment of retrograde ejaculation

Retrograde ejaculation is an uncommon but treatable form of male infertility. Successful recovery of motile spermatozoa from a post-ejaculatory urine for artificial insemination is dependent on careful regulation of osmolarity and acidity of the bladder contents into which the ejaculate emanates, and the separation of the motile spermatozoa from the debris and cells which are found in these specimens. A pregnancy established by artificial insemination of spermatozoa recovered from bladder contents of a patient suffering from retrograde ejaculation is presented. The techniques for preparing the urinary bladder for spermatozoal survival and the removal of debris and cells by delicate centrifugation are discussed.     

Successful artificial insemination with spermatozoa recovered from the urine in a case of retrograde ejaculation

A case of retrograde ejaculation due to transurethral prostatic endoresection is described, where successful artificial insemination with the first drops of urine collected after natural coitus, and containing large numbers of spermatozoa, was achieved by the male himself.     

Pregnancy by insemination of cryopreserved spermatozoa from a man with retrograde ejaculation: a case report

BACKGROUND: Owing to the prevalence of diabetes mellitus, spinal injuries and aggressive surgical treatment of cancer, the number of younger patients with retrograde ejaculation is increasing. Since medical treatment to restore antegrade ejaculation often fails, several options for accomplishing insemination by these patients, including the use of sperm-rich urine obtained after masturbation and in vitro fertilization with sperm retrieved from the seminal tract, have been reported. We used the least invasive and most inexpensive procedure in a patient/couple with this condition. CASE: A 23-year-old man suffered from retrograde ejaculation after a spinal injury. He could achieve erection and engage in sexual intercourse but seldom had an orgasm or the sensation of ejaculation. We obtained spermatozoa from urine produced after masturbation at home and froze them. We used these frozen-thawed spermatozoa for intrauterine insemination, leading to the term birth of a healthy infant. CONCLUSION: In selected patient/couples, frozen spermatozoa obtained from postmasturbation urine can be used successfully for intrauterine insemination. This minimally invasive and most inexpensive procedure should be tried before planning in vitro fertilization.     

Sperm retrieval for direct intraperitoneal insemination in a diabetic with retrograde ejaculation. A case report.

Retrograde ejaculation is an uncommon form of male infertility. It may occur in diabetics from neuropathy involving the sympathetic fibers innervating the bladder neck. Treatment of infertility in these cases is with artificial homologous insemination. Several techniques for semen recovery from the bladder have been proposed. This paper describes a case of twin pregnancy following direct intraperitoneal insemination (DIPI) of semen retrieved from a diabetic man with retrograde ejaculation. Retrieval of semen was performed in this case by spontaneous voiding of urine after the introduction of a suitable medium into the bladder and before ejaculation. The quality of the semen was examined after spontaneous urination before DIPI. The poor quality of the spermatozoa induced us to introduce into the bladder a suitable medium before ejaculation and sperm recovery.     

Retrograde ejaculation: a more convenient method for artificial insemination

A case of retrograde ejaculation not responding to medical treatment is described in which the problem of sterility was overcome by artificial insemination. The semen was collected from urine after coitus by previous alkalinization with 1.63 g NaHCO₃ once daily. Pregnancy occurred at the 4th insemination during the 1st treatment cycle. This technique seems to be the most suitable for artificial insemination in cases of retrograde ejaculation.     

Retrograde ejaculation: etiology and treatment via the use of a new noninvasive method

Retrograde ejaculation (RE) is not a common infertility problem, but has increased in incidence recently due to surgical aggressiveness in pelvic and genital malignancies. However, RE is the most common cause of aspermia, or absence of ejaculate at orgasm. Meanwhile, surgical or drug therapy methods have not been very promising in regaining normal antegrade ejaculation. As yet, the standard procedures for treatment of RE involve the artificial insemination of either nonprocessed or processed (via centrifugation and resuspension) postcoital voided bladder contents. RE specimens in this study were collected after postcoital voiding into a TEST buffer and resuspended in TEST-yolk buffer. The urine effects on the voided spermatozoa were studied. The technique employed in this study assists in the recovery and reconstitution of RE fit for artificial insemination.     

Homologous Artificial Insemination Following Retrograde Ejaculation

Summary: A case is reported of successful homologous artificial insemination using semen recovered from the bladder following retrograde ejaculation. The technique for spermatozoa protection and preservation is described.     

Successful artificial insemination in a case of retrograde ejaculation.

A case is described of retrograde ejaculation due to bladder neck resection followed by ileal conduit with a non-functioning bladder, where, after unsuccessful attempts at artificial insemination with spermatozoa retrieved from the bladder, ejaculate was obtained at defecation followed by artificial autoinsemination by the male, leading to two consecutive pregnancies.     

Retrograde ejaculation: successful treatment with artificial insemination.

Retrograde ejaculation is characterized by aspermia or oligospermia and results from an incompetent bladder neck, often due to a dysfunction of the internal sphincter. In almost 3 years, eight couples who suffered from infertility due to retrograde ejaculation were treated with inseminations with spermatozoa gained from the urine. Ovulation was predicted on the basis of blood LH levels. The urine-semen sample was collected in 100 mL of Hepes medium and 5 mL 1% human albumin (pH 7.4). After centrifuging, the remaining sperm pellet was dispersed on a Percoll gradient. After centrifuging and resuspending, followed by two washing procedures with Ham's F-10 and human albumin 1%, the remaining sample was used for intrauterine insemination. Twelve pregnancies were thus achieved; two women became pregnant twice and one three times. The pregnancy rate per cycle was 44.4%. In seven couples, pregnancy was achieved within three cycles. Four pregnancies ended in spontaneous abortion and five ended in the birth of a healthy child; three pregnancies were continuing at the time of writing. Retrograde ejaculation can be treated successfully with inseminations using spermatozoa obtained from urine. It seems important to collect the urine-semen sample in a buffered medium and to time the insemination on the basis of the LH surge.     

Sperm recuperation and cervical insemination in retrograde ejaculation

Seven infertile patients with retrograde ejaculation, in which spermatozoa could be recuperated from the postejaculation urine, were admitted to a sperm recuperation and cervical insemination program. A noninvasive method for sperm recuperation based on urine alcalinization and serial controls to time masturbation has been used. Insemination has been timed according to BBT charts and cervical mucus characteristics. Pregnancy has been obtained in the seven couples after one to eight treatment cycles.     

A Case of Successful Use of Reproductive Technology for a Couple with Subfertility Due to Retrograde Ejaculation, Where Artificial Insemination had Failed

Summary: A case history of a couple where the infertility was due to retrograde ejaculation is presented; when conventional treatment with artificial insemination using sperm isolated from postejaculatory urine failed, IVF and GIFT technology was applied. This resulted in a pregnancy which unfortunately failed at 3 months, unrelated to the method of conception. This case report highlights the possible use of IVF/GIFT for yet another type of male subfertility.     

The leukocytic reaction of the human uterine cervix to spermatozoa

Cervical smears were taken before, and at intervals after, artificial insemination and scored for the ratio of leukocytes to squamous cells. Most women showed a significant rise in this ratio after insemination with whole fresh or frozen/thawed semen, but this was not seen when fresh or frozen sperm-free seminal plasma was used. Some women had received spermatozoa naturally less than 24 hours before our tests, and most showed some leukocytosis before insemination; even these women showed further response to artificial insemination with spermatozoa. It is concluded that women, like rabbits, normally respond by leukocytosis to cervical deposition of spermatozoa. The primary function of the leukocytes may be sperm selection by phagocytosis or the "mopping up" of introduced bacteria. Some of the patients became pregnant at the monitored cycle; so it is very clear that this is a physiologic response of the cervix, not a pathologic leukocytic reaction.     

Successful treatment of retrograde ejaculation with sperm recovered from bladder washings. A report of two cases

BACKGROUND: Retrograde ejaculation causes < 2% of male infertility but is the leading cause of aspermia. The incidence of retrograde ejaculation is increasing due to the aggressiveness of modern urologic cancer surgery and an increase in diabetes mellitus. Generally, the only adverse effect is on fertility. Various approaches have been proposed for treatment, ranging from insemination with sperm-rich urine obtained after masturbation to intracytoplasmic sperm injection (ICSI). We used a protocol involving bladder washing. CASES: Case 1 involved a man with retrograde ejaculation secondary to a successful right orchiectomy and retroperitoneal lymph node dissection for stage B1 embryonal cell carcinoma. He was treated with bladder washing and intrauterine insemination. He fathered three children from six insemination cycles. Case 2 involved a man with idiopathic retrograde ejaculation and a wife with ovulatory dysfunction. He received treatment similar to that in case 1 and fathered one child from two insemination cycles. CONCLUSION: Larger studies need to be done specifically comparing treatments. Our method resulted in four normal infants in two couples over eight total insemination cycles and, taken together with other results from the literature, seems a good choice for clinicians who are treating retrograde ejaculation for the first time. We agree with others who have recommended that in vitro fertilization/ICSI not be the first step for treating the usual couples with retrograde ejaculation.     

A simple and effective technique for increasing pregnancy rates in couples with retrograde ejaculation

Seven of 12 patients with retrograde ejaculation, who had at least occasional samples with reasonable sperm numbers and motility, underwent a protocol including luteinizing hormone-timed, intrauterine insemination with washed sperm recovered from the urine. Seven pregnancies have occurred to date in six patients; the one other patient is still early in the protocol period. The described technique for collecting sperm, ovulation timing, sperm recovery, and washing and intrauterine insemination are relatively simple and cost-effective and appear to be effective in contributing to pregnancies in many couples with retrograde ejaculation.     

In defense of a function for the human epididymis

In view of reports that the human epididymis may play no role in human fertility, literature on the fertilizing capacity of epididymal spermatozoa was reviewed. The survey indicates that under the circumstances of their retrieval, human epididymal and testicular spermatozoa may have the ability to fertilize human eggs both in vivo and in vitro. Although the "fertility profile" of the normal epididymis cannot be explored in man, a fair assumption would be that fertilizing capacity develops fully in the distal part of the tract, judging from the higher motility and egg fusing ability of sperm taken from these regions of unobstructed tissue. Motility and fertilizing capacity observed with IVF or artificial insemination, in which sperm are obtained from obstructed ducts, may occur at a level in the tract more proximal than normal, as in animals. The pregnancies resulting from aspiration of spermatozoa from, or anastomosis of the vas deferens to, the efferent ducts are of great clinical interest, but the pathological state of the tissue precludes definitive statements about the functioning of a normal epididymis. In the former case, the immediate origin of the fertilizing spermatozoon and the nature of the secretions previously bathing it are unknown and in the latter case the time needed before pregnancies occur is much greater than anticipated had fertile sperm been present in the proximal epididymis. The evidence supports neither the view that testicular sperm are inherently fertile nor that a simple aging of sperm cells is sufficient for the fertilizing potential of spermatozoa to be realized. It emphasizes, rather, the importance of the environment to which the sperm cells are subjected. Under abnormal conditions other accessory glands may secrete compounds that are necessary for the maturation of spermatozoa. Before more information is known of the exact situation existing, or having existed, in pathological human tissues from which fertilizing human spermatozoa can be obtained, great caution should be exercised in interpreting the results of pregnancies arising from the in vivo and in vitro insemination of testicular or epididymal spermatozoa.     

Deep intrauterine insemination in cattle

INTRODUCTION: Most of the artificial inseminations in cattle nowadays are being performed in the uterine body with a rigid insemination device. Uterotubal junction insemination can only be performed in cattle with a device which is rigid enough to pass the cervix and flexible enough to follow the curvature of the uterine horns. At the Faculty of Veterinary Medicine in Ghent, a new insemination device has been developed for semen deposition near the utero-tubal junction in cattle and other animals. MATERIALS AND METHODS: In a first field trial the feasibility of the newly developed Ghent device was evaluated. Four thousand sixty-four dairy cows were inseminated by 12 inseminators with a standard insemination dose (10-15 million of frozen-thawed spermatozoa). Three insemination methods were compared; group 1: insemination in the uterine body with the conventional insemination device, group 2: insemination in the uterine body with the Ghent device, and group 3: insemination in the tip of both uterine horns with the Ghent device. In a second field trial insemination of dairy cows with the Ghent device was compared with the conventional insemination technique to evaluate the effect on pregnancy rates. The insemination dose was lowered to eight million (trial 1), four million (trial 2), and finally to two million frozen-thawed spermatozoa (trial 3). In each field trial, cows were divided into three groups: the first group was inseminated with a full insemination dose (12 x 10(6)) in the uterine body with the conventional insemination device, the second group with a lowered insemination dose in the uterine body with the conventional insemination device, and the third group with a lowered insemination dose in the tip of both uterine horns with the Ghent device. It can be concluded that decreasing the insemination dose from 12 to four million frozen-thawed spermatozoa had no effect on pregnancy rate in our experiments, neither with the conventional insemination device, nor with the Ghent device. The device is made of disposable materials and has been tested to be non-toxic for bovine spermatozoa, can be used by one person and is adapted for application in the field. Conclusion: In the near future, similar field trials will be performed with even lower doses of semen. It is only in these cases that we truly hope to show a positive effect of uterotubal junction insemination by using low quality semen or by using sexed semen.     

Individual fertility differences in the frozen-thawed spermatozoa among semen donors in the Labrador Retriever

Purpose  We aimed to validate and determine the possible application of transcervical insemination of frozen semen for improved breeding in guide dogs for the blind in Japan. Methods  From February 2004 to March 2007, a total of 53 Labrador Retriever bitches, used for the breeding of guide dogs for the blind, were transcervically inseminated with frozen-thawed semen from 13 males by means of a cystoscope. Results  The overall whelping and pregnancy rate with the frozen semen was 42%. Pregnancy rates ranged widely from 0 to 100% depending on the semen donor male. Of 13 males, 6 males exhibited severely poor fertility (less than 20% pregnancy rate) and 3 males exhibited high fertility (over 70% pregnancy rate) on artificial insemination. However, the spermatozoa motility after thawing was not significantly different among these dogs. In addition, heterospermic insemination revealed the optimal timing for transcervical insemination with frozen-thawed semen to be by day 6 after the LH surge. Conclusions  Although transcervical insemination of frozen-thawed semen is effective for breeding of guide dogs for the blind, some modification of freeze-thawing procedures might be required to overcome individual fertility differences in the frozen-thawed spermatozoa among semen donor dogs,. In addition, the motility of spermatozoa after thawing might not be an appropriate indicator of the relative fertility of frozen-thawed spermatozoa in dogs.     

Timing of Ovulation by Determination of the Urinary Luteinizing Hormone Surge with an Enzyme-linked Monoclonal Antibody Dipstick (OvuStick)

An enzyme-linked double monoclonal antibody dipstick for measuring luteinizing hormone in urine was tested for timing ovulation in thrice daily urine samples collected for several days around mid-cycle in 24 women undergoing artificial insemination. The assay produced information comparable to single daily serum LH measurements. The dipsticks could be used by untrained people to test their own urine as an aid to the detection of ovulation for the timing of artificial insemination or of sexual intercourse to promote or avoid conception.     

Artificial insemination with donor frozen sperm

The cryopreservation of human sperm decreases its fecondity, by reduction in the number of motile sperm. However the fertilizing ability of the spermatozoa is not faded. The use of frozen sperm requires an optimization of the methods of artificial insemination to hope to approach the results obtained with fresh sperm. Intrauterine insemination with sperm selection meets this aim.