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.     

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.     

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.     

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.     

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.     

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.     

Comparison of intrabursal transfer of spermatozoa,a new method for artificial insemination in mice,with intraoviductal transfer of spermatozoa

Purpose : The objective of this paper was to compare the in vivo fertilizing abilities of fresh epididymal spermatozoa with a new method of artificial insemination in mice, so-called intrabursal transfer of spermatozoa (ITS), which requires transfer of spermatozoa into a space near the infundibulum between the ovary and ovarian bursa of superovulated females, and the previous method, so-called intraoviductal transfer of spermatozoa (IOTS), especially as regards sperm number and capacitation. Methods : Spermatozoa freshly isolated from B6C3F1 males were injected into superovulated B6C3F1 females on E 0.4 (10:00 AM) by the IOTS or ITS method. Embryos at two-cell stage were collected from the females 1 day after injection and their morphology was scored. Some females were allowed to survive at midgestational stages and inspected for development of normal fetuses. Results : When 1 L of a sperm suspension containing uncapacitated 1 × 10⁵ spermatozoa freshly isolated from B6C3F1 males was injected by the IOTS or ITS method, normal two-cell embryos were recovered from the females at rates ranging from 14 to 23% with each method. This rate was much lower than that (93% on average) for embryos obtained by natural mating. Neither injection of 1 × 10³ or 1 × 10⁴ spermatozoa nor induction of capacitation improved in vivo fertilization rate. In both cases, females given spermatozoa exogenously yielded midgestational fetuses (E 12.5–13.5) with average litter sizes between 2.5 and 2.8. Conclusion : ITS was comparable to IOTS with the conditions used. These two methods will be valuable for artificial insemination in mice for propagation of offspring from particular transgenic or mutant lines that are difficult to breed, although further attempts to improve in vivo fertilization ability are required.     

Intrauterine insemination of washed husband's spermatozoa: a controlled study

We performed intrauterine insemination with washed husband's spermatozoa in 27 couples with clear evidence of impaired sperm mucus interaction due to cervical hostility or immunologic male subfertility and in 30 couples with subnormal semen, but optimal cervical mucus qualities. In each couple insemination cycles were alternated with cycles during which normal intercourse took place. Both types of cycles were monitored for LH. When a clear rise of LH levels could be detected, either IUI was scheduled or intercourse advised for the following day. In the male subfertility group no difference between the pregnancy rates of insemination and intercourse cycles was present. In the group with impairment of sperm-mucus interaction, the pregnancy rate of the insemination cycles was 16%, whereas no pregnancies occurred during intercourse cycles.     

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.     

Influence of ultrasound-guided artificial insemination on pregnancy rates: a randomized study

Purpose

To evaluate the influence of ultrasound guidance during intrauterine insemination (IUI) on pregnancy rates (PRs). The impacts of two different groups of providers were also investigated.

Methods

Study population consisted of 387 gonadotropin stimulated IUI cycles performed for unexplained infertility. The patients were randomized into two groups as ultrasound-guided IUI (n = 180) and classical IUI (n = 207). Pregnancy rates were compared. Two groups were further analyzed based on the experience of the provider (senior versus junior subgroups) who performed IUI.

Results

Pregnancy rates were higher in the ultrasound-guided IUI group (17.2 %) compared to the classical IUI (10.1 %) (p = 0.042). In further analysis based on the experience of the provider; in the classical IUI group, PRs were similar for both subgroups, however, in the ultrasound-guided group it was higher when IUI was performed by a senior physician (21.7 versus 9.2 %, p = 0.033). Logistic regression revealed that the experience of the provider was the independent variable for improved PRs.

Conclusions

Ultrasound guidance improves PRs only when a senior provider performs the IUI procedure. It seems that the experience of the provider physician is one of the determinants of IUI success.     

Homologous artificial insemination for oligoasthenospermia: a randomized controlled study comparing intracervical and intrauterine techniques

Homologous artificial insemination (AIH) is used to treat infertility caused by oligoasthenospermia, despite the lack of controlled studies confirming its benefit. This prospective randomized controlled trial was undertaken to determine whether intracervical (IC-AIH) or intrauterine (IU-AIH) homologous artificial insemination improves pregnancy rates in couples with infertility attributable to oligoasthenospermia alone. Twenty couples were randomized to receive IC-AIH or IU-AIH. Sixty-three insemination cycles were completed. During the same study period, 35 cycles with timed vaginal intercourse alone were assessed. Four pregnancies occurred, all following timed vaginal intercourse. No pregnancies resulted from IC-AIH or IU-AIH. This suggests that neither IC-AIH nor IU-AIH is of benefit when oligoasthenospermia is the cause of infertility. Pregnancies previously attributed to AIH may also have been conceived as a result of vaginal intercourse. This confounding effect on the results of AIH should always be considered.     

Causes of aberrant non-invasive prenatal testing for aneuploidy: A systematic review

Non-invasive prenatal testing (NIPT) is performed worldwide to detect common chromosomal aneuploidies. The analysis of cell-free DNA (cfDNA) in maternal blood for NIPT is highly accurate for the detection of the main fetal trisomies: 21,18, and 13. However, false-positive, false-negative, and non-reportable results can occur, and these can have biological causes. Understanding the causes of unexpected NIPT results is essential to enable clinicians and genetic counselors to counsel patients comprehensively and appropriately, both prior to testing as well as after receiving the test results. The classification of non-reportable results from cfDNA analysis is important in order to provide women with precise information. In addition to technical issues, there are biological reasons for discordant results, which can be either fetal or maternal in origin. Contributing fetal factors include insufficient or absent fetal fraction, fetoplacental mosaicism, and the presence of a vanishing twin. In some pregnant women that test positive for NIPT, multiple chromosome aneuploidy has been reported as a result of suspected malignancy, and cancer has been found. False-positive and false-negative results may be the result of placental biology and not a failure in the actual test platform. Explaining the placental origin of cfDNA provides the patient with a clear view of the abilities and limitations of cfDNA-based prenatal screening.     

Intrapartum care quality indicators: a systematic approach for achieving consensus

Objective

To identify published maternity intrapartum quality indicators and rationalise them to a core set.

Study design

Prospective qualitative consensus group exercise. A literature search identified sets of intrapartum quality indicators in the English language. These were rationalised to a shortlist using criteria adapted from ‘The Good Clinical Indicator Guide’. An expert panel from key UK professions and organisations utilised a modified Delphi process to devise a final agreed set of intrapartum quality indicators that are specific, measurable, modifiable and relevant to clinical practice. Each indicator was rated in two rounds of web-based surveys, followed by a final face-to-face meeting of the panel.

Results

290 clinical indicators were identified within 96 clinical categories with up to 18 different definitions. After rationalisation, 10 core and 24 additional quality indicators entered the Delphi process. A final panel of 12 indicators was defined.

Conclusions

By using a simple Delphi process we have defined a set of broad clinical quality indicators that provide a comprehensive coverage of labour and delivery outcomes. We believe that this pragmatic portfolio will be useful for many wishing to develop performance monitoring and maternity dashboard systems.