ABSTRACT
There is often inherent conflict in the overlapping fields of male fertility and andrology. While the goal of all male fertility specialists is to facilitate and preserve biologic paternity, many practitioners also care for a significant number of patients suffering from hypogonadism. Exogenous testosterone administration, the gold standard for the management of these patients, almost universally impairs spermatogenesis and can even completely eradicate it in some men. With steady increases in both the incidence of hypogonadism and average paternal age, practitioners are now encountering hypogonadal men who desire future fertility or men suffering the effects of earlier androgenic anabolic steroid use with increasing frequency. In this manuscript, we review management strategies for these complex patients and explore novel medications that may be of use in this population.
ABSTRACT
Aging results in erectile dysfunction that is partially attributed to decreased nitric oxide [NO] and increased free radical generation. Vitamin E enhances endothelial cell function and acts as a free radical scavenger; however, its benefits on erectile function in the elderly are unknown. The aim of the following study is to determine if Vitamin E alone, or in combination with the phosphodiesterase 5 inhibitor sildenafil, may improve erectile function and the NO signaling in a cohort of aged [13-15 month old] rats. Male Sprague-Dawley rats [n = 28] were divided based upon age into young [4-5 months old, n = 7] and aged [13-15 months old, n = 21] cohorts. Aged rats were treated with Vitamin E, sildenafil or a combination of both. Penile cavernosal and dorsal nerve tissues were evaluated for neuronal nitric oxide synthase [nNOS] and caveolin-1 expression. Erectile function was assessed through intra-cavernous pressure [ICP] recordings. nNOS and cavoelin-1 were significantly decreased in aged rats compared with young controls. In aged rats, both Vitamin E and sildenafil partially recovered nNOS expression but when combined, a synergistic elevation in nNOS was observed. The significant decreases in ICP recorded in aged rats were improved with sildenafil; however, Vitamin E did not yield any additional improvements in ICP. Diminished levels of nNOS and caveolin-1 are found in aged rats. When combined with sildenafil, Vitamin E synergistically increased nNOS expression. Since biochemical gains were not realized physiologically, other contributing factors likely exist
ABSTRACT
Obstructive azoospermia [OA] is characterized by normal spermatogenesis and the absence of sperm in the ejaculate. Variable success rates have been reported using in-vitro fertilization [IVF] combined with PESA in cases of men with OA. To determine fertilization and pregnancy outcomes from PESA-derived spermatozoa and to ascertain whether frozen spermatozoa yields similar outcomes compared to fresh specimens. The charts of 68 consecutive couples undergoing 68 cycles of sperm retrieval for OA over eight years [2002-2010] were retrospectively reviewed. Patients requiring testicular intervention were excluded [n = 17]. Viable sperms were identified in 100% of men, and fresh spermatozoa were obtained in 40 patients [78.4%] simultaneously with female egg retrieval. The average fertilization rate was 77.7% with five embryos not surviving to transfer [12.5%]. Pregnancies were confirmed in 48.6% [17/35]. Twin gestations occurred in 11.8% [2/17] of cases. Frozen-thawed spermatozoa were used in 11 patients [21.6%]. In this subgroup, the average fertilization rate was 73.6% with pregnancies confirmed in 54.5% [6/11]. No multiple gestations were generated, and no complications occurred. The use of fresh spermatozoa for PESA provided no significant improvements in outcomes over frozen specimens. PESA is a very effective, simple, and safe method of obtaining spermatozoa for IVF. Outcomes obtained using fresh and frozen PESA-derived spermatozoa were similar and as such, either could be used during the IVF process