A web-based decision aid for shared decision making in pelvic organ prolapse: the SHADE-POP trial.

INTRODUCTION AND HYPOTHESIS: Among women worldwide, pelvic organ prolapse (POP) is a common problem. There are three different treatment options for POP: pelvic floor muscle therapy, pessary treatment and prolapse surgery. As none of the three treatment options is clearly superior, shared decision making (SDM) is very important. A decision aid (DA) is known to facilitate patient participation and SDM. We hypothesise that the use of a web-based DA for POP increases patients' satisfaction with information and care and reduces decisional conflict. METHODS: This two-arm, multicentre, cluster randomised controlled trial was performed in women with POP in five different Dutch hospitals. The control group received usual care (UC) and the intervention group received the DA in addition to UC. Primary outcome measures were satisfaction with treatment decision making and satisfaction with information. Analyses were performed using independent sample t tests, Chi-squared tests, and multilevel linear regression analyses. RESULTS: Between the DA group (n=40) and the UC group (n=56) no differences were found concerning patients' satisfaction with information, with scores of 45.63 and 46.14 out of 50 respectively (p=0.67). Also, no differences were found concerning the perceived role in decision making, as patients scored 46.83 in the DA group and 46.41 in the UC group, out of a maximum of 54 (n=0.81). CONCLUSIONS: No differences were found concerning patients' satisfaction with information and treatment decision making between the DA and UC. However, both groups scored high on the questionnaires, which suggests that the decision process is already of high quality.

Intracytoplasmic sperm injection in partial globozoospermia.

OBJECTIVE: To compare the outcome of intracytoplasmic sperm injection (ICSI) in patient couples where the male partner has partial globozoospermia with the outcome in a general ICSI population. DESIGN: Case-control study. SETTING: Center for Reproductive Medicine, Radboud University Nijmegen Medical Center, the Netherlands, a tertiary referral center. PATIENT(S): Between 1997 and 2005, 42 couples were identified in which the male presented with partial globozoospermia; 27 couples treated with ICSI were matched with 263 control couples from a general ICSI population regarding female age and year of first ICSI cycle. INTERVENTION(S): One ICSI treatment (1-10 ICSI cycles). MAIN OUTCOME MEASURE(S): Live birth rate after one ICSI treatment (1-10 ICSI cycles). RESULT(S): In the partial globozoospermia group, the live birth rate was 66.7% compared with 50.0% in the control group. In partial globozoospermia, three out of 21 pregnancies ended in a miscarriage, one major birth defect occurred, and one pregnancy ended in a neonatal death due to sepsis in a premature child, compared with four stillborn in the control group. CONCLUSION(S): ICSI is an effective treatment in couples that failed to conceive spontaneously within 1 year combined with male infertility due to partial globozoospermia. The fertilization rates and the live birth rates in this specific group did not differ from those of the general ICSI population.

Morphology of partial globozoospermia.

Total globozoospermia is a rare sperm morphology disorder that consists of 100% round-headed, acrosomeless spermatozoa. There is also a larger group of patients whose sperm cells are partially acrosomeless. The aim of this investigation was to describe partial globozoospermia compared to total globozoospermia and normozoospermia. Ejaculates from 10 patients with more than 50% acrosomeless spermatozoa (partial globozoospermia), 3 patients with total globozoospermia, and 9 normozoospermic controls were analyzed with light microscopy, transmission electron microscopy, and flow cytometry. Qualitative and quantitative examination of spermatozoa from the 3 groups shows differences in the percentage of round-headed sperm cells and acrosome malformation. Total globozoospermia presents as a homogenous kind of teratozoospermia. Partial globozoospermia is a distinctive sperm malformation with an increased proportion of round-headed sperm cells and acrosome malformations compared to normozoospermia, which exists separately from total globozoospermia. It thereby contains oval sperm cells that may have distinctive malformations of the sperm head matrix, but also morphologically normal sperm cells that may be used in a clinical setting.

Homozygous mutation in SPATA16 is associated with male infertility in human globozoospermia.

Globozoospermia is a rare (incidence <0.1% in male infertile patients) form of teratozoospermia, mainly characterized by round-headed spermatozoa that lack an acrosome. It originates from a disturbed spermiogenesis, which is expected to be induced by a genetic factor. Several family cases and recessive mouse models with the same phenotype support this expectation. In this study, we present a consanguineous family with three affected brothers, in whom we have identified a homozygous mutation in the spermatogenesis-specific gene SPATA16. This is the first example of a nonsyndromic male infertility condition in humans caused by an autosomal gene defect, and it could also mean that the identification of other partners like SPATA16 could elucidate acrosome formation.