Sperm retrieval during critical illness.

Objective of this study is to review technical methods to retrieve sperm from critically ill/injured patients after an appropriate family request, possible harmful effects on sperm production/function by ICU medications or concurrent illnesses, and ethical considerations for hospitals and care providers in providing this resource. Design used for this study includes: literature review, PubMed 1998-2009, and authors' files. There are no interventions.

Socioeconomic, anthropomorphic, and demographic predictors of adult sexual activity in the United States: data from the national survey of family growth.

Introduction: Individuals who engage in regular sexual intercourse are more likely to report good overall quality of life. Studies of sexuality in adolescents have focused on high-risk behaviors whereas similar studies in older adults have focused on sexual dysfunction. Given a paucity of data on the sexual behaviors of young adults and the possibility of important relationships between sexuality and overall health, we sought to determine factors that influence the frequency of intercourse in adult men and women in the United States.

The quantitative ADAM questionnaire: a new tool in quantifying the severity of hypogonadism.

Androgen deficiency is a pervasive problem in the older male population and is thought to be responsible for many symptoms once considered to be the result of normal aging. Numerous methods have been proposed to facilitate the detection of men at risk for androgen deficiency. In this article, we propose a novel screening tool, the quantitative Androgen Deficiency in the Aging Male (qADAM) questionnaire and report its successful use in quantifying the severity of androgen deficiency in a group of older men.

Techniques for vasectomy reversal.

This article details the contemporary preoperative preparation, microsurgical techniques, and postoperative care recommended for vasectomy reversal. The two-layer vasovasostomy and intussuscepted epididymovasostomy techniques are presented in detail.

Correlation of degree of penile curvature between patient estimates and objective measures among men with Peyronie's disease.

Introduction: : Among men with Peyronie's disease (PD), the degree of penile curvature has significant implications on psychological well-being, sexual function, treatment planning, and posttherapy evaluations.

Aim: The primary objective of the current study was to correlate patients' estimates of penile angulation with objective measures.

Main Outcome Measures: (i) Proportion of patients over- or underestimating their actual degree of curvature; and (ii) degree differences between patient estimates and objective measures of penile curvature.

Why treat the male in the era of assisted reproduction?

The concept of unilateral care of the female partner has gained momentum in the reproductive health community, especially with the advent of in vitro fertilization and intracytoplasmic sperm injection. Herein, the authors examine the existing evidence in support of evaluating and treating the male patient as part of the routine evaluation of the infertile couple. This evidence includes assessments of efficacy, cost-effectiveness, and safety, and-- when considered broadly--argues strongly against unilateral care.

Testosterone replacement therapy following radical prostatectomy.

Introduction: Controversy exists regarding testosterone replacement therapy (TRT) in men following radical prostatectomy (RP). Many clinicians are hesitant to offer patients TRT after an RP, out of concern that the increased androgen levels may promote tumor progression or recurrence from residual tumor. Recently, several small studies have demonstrated the use of TRT in men following an RP and have shown an improvement in serum testosterone levels with no increase in prostate-specific antigen (PSA) values.

Construct validity of the pig intestine model in the simulation of laparoscopic urethrovesical anastomosis: tools for objective evaluation.

Purpose: We examined the construct validity of a porcine-intestine model for ultimately performing a laparoscopic urethrovesical anastomosis.

Materials And Methods: Pig intestine was used to create a model for laparoscopic urethrovesical anastomosis (L-UVA) performed laparoscopically in the LapTrainer. Twelve subjects (residents and medical students) with different levels of experience in laparoscopy were divided into three groups depending on their previous level of training with the laparoscope and with robot-assisted laparoscopic prostatectomy (RALP).

Pretreatment semen parameters in men with cancer.

Purpose: Whether the presence or specific type of cancer significantly affects semen quality is controversial. We evaluated the semen parameters and associated malignancies of men with cancer who cryopreserved sperm at our institution before undergoing therapy.

Materials And Methods: We reviewed the database from our cryopreservation laboratory during a 5-year period.

Correlation between simultaneous PSA and serum testosterone concentrations among eugonadal, untreated hypogonadal and hypogonadal men receiving testosterone replacement therapy.

The primary objective of this study was to correlate simultaneous measures of prostate-specific antigen (PSA) and serum testosterone among large samples of eugonadal, untreated hypogonadal and hypogonadal men treated with testosterone replacement therapy (TRT). From 2001 to 2007, laboratory records were reviewed to identify men who underwent simultaneous measurement of PSA and serum testosterone levels. The data were stratified based on three groups of men: group 1 consisted of eugonadal men (T>300 ng per 100 ml) evaluated for BPH, reproductive failure or sexual dysfunction; group 2 consisted of untreated hypogonadal men (T<300 ng per 100 ml); and group 3 comprised symptomatic hypogonadal men receiving TRT.

Randomized, double-blind, placebo-controlled study of postoperative nightly sildenafil citrate for the prevention of erectile dysfunction after bilateral nerve-sparing radical prostatectomy.

Four weeks after bilateral nerve-sparing radical retropubic prostatectomy, men with normal erectile function before surgery were randomized to double-blind sildenafil (50 or 100 mg) or placebo nightly for 36 weeks, followed by an 8-week drug-free period before assessment of erectile function. Enrollment was prematurely ceased and only 76 men completed because, assuming a placebo response rate similar to the published literature (for example, 34% in meta-analysis), the 25% response at blinded interim review suggested a lack of treatment effect. On the contrary, spontaneous erectile function (a combined score of >or=8 for questions 3 and 4 of the International Index of Erectile Function and a positive response to 'Were erections good enough for satisfactory sexual activity?') occurred in only 4% of the placebo group (n=1 of 25) versus 27% (n=14 of 51, P=0.

Evolving approach to the varicocele.

The varicocele is the most common cause of male infertility world wide. Varicoceles have been found in 15% of the normal male population and in up to 40% of patients with male infertility. In approximately 70% of patients with secondary infertility, a varicocele is an underlying cause.

Safety of assisted reproduction, assessed by risk of abnormalities in children born after use of in vitro fertilization techniques.

Assisted reproductive technologies are increasingly used in the treatment of both male and female infertility. The techniques, including in vitro fertilization, with or without intracytoplasmic sperm injection as an adjunctive treatment, represent a tremendous step forward for infertile couples who previously had no treatment options. As we move towards the 30(th) anniversary of the birth of the first baby conceived by in vitro fertilization, questions about the safety of these procedures linger.

The role of testosterone replacement therapy following radical prostatectomy.

Hypogonadism is highly prevalent in older men and men who have prostate cancer. The symptoms of hypogonadism, such as depression, decreased libido, erectile dysfunction, and decreased bone mineral density, can significantly impair a man's quality of life. Moreover, we know that testosterone plays an important role in erectile preservation and in the growth and function of cavernosal and penile nerves.

Efficacy of changing testosterone gel preparations (Androgel or Testim) among suboptimally responsive hypogonadal men.

The study objective was to evaluate the efficacy of changing testosterone gel preparations among suboptimally responsive hypogonadal men. The records of all hypogonadal men on gel (Testim or Androgel) testosterone replacement therapy (TRT) were reviewed to identify men who underwent a brand substitution in gel TRT due to initial suboptimal response. Total and free serum testosterone levels and the presence of hypogonadal symptoms (ADAM) were compared pre- and post-gel substitution.

Compound genetic abnormalities in patients with cystic fibrosis transmembrane regulator gene mutation.

Objective: To determine the prevalence of compound genetic abnormalities in patients who are carriers of cystic fibrosis mutations.

Design: Case report.

Setting: Tertiary referral center for male infertility.

Vasectomy reversal: new techniques and role in the era of intracytoplasmic sperm injection.

The growing popularity of vasectomy as a primary form of birth control has also created an increasing demand for vasectomy reversal (VR). The advent of IVF with intracytoplasmic sperm injection after sperm retrieval has given couples an alternative to traditional VR. Although VR remains the most cost-effective and natural way to conceive after vasectomy, competing interests and market pressures have encouraged the development of this assisted reproductive technique (ART).

Varicocele: surgical techniques in 2005.

Varicocele is the most common diagnosis in men presenting to fertility clinics. Traditional indications for correction of varicocele include scrotal pain, testicular atrophy, and infertility without other apparent causes. Adolescent varicocele correction is indicated if pain or testicular growth retardation is present.

IVF and ICSI in male infertility: update on outcomes, risks, and costs.

Assisted reproductive technology with intracytoplasmic sperm injection (ICSI) is becoming an international panacea for couples struggling with infertility. The increasing popularity of these techniques and the data generated has given us a better understanding of the efficacy, consequences and costs of these procedures. There still remain many unanswered questions and controversies surrounding the use of IVF and ICSI.

Herniorrhaphy with polypropylene mesh causing inguinal vasal obstruction: a preventable cause of obstructive azoospermia.

Objective: To report a multiinstitutional experience of men presenting with infertility secondary to inguinal hernia repair using polypropylene mesh.

Summary Background Data: An estimated 80% of inguinal hernia operations involve placement of a knitted polypropylene mesh to form a "tension-free" herniorrhaphy. The prosthetic mesh induces a chronic foreign-body fibroblastic response creating scar tissue that imparts strength to the floor and leads to fewer recurrences.

Treatment options for the infertile male with cancer.

The detrimental effects of cancer on male fertility are multifactorial and may be secondary to the disease process itself or to therapeutic interventions. Patients and their doctors need to be better informed about the options men with cancer have to preserve their fertility status. Sperm banking is a safe and effective means of storing sperm before chemotherapy, radiotherapy, or surgery.

Survey brings no surprises.

The findings gleaned from the 1,291 responses to a survey of American Society for Reproductive Medicine members offer no surprises. However, the responders might have been self-selected from among those most interested in the organization's "news and views."