Risk of diabetes according to male factor infertility: a register-based cohort study.

STUDY QUESTION: Is male factor infertility associated with an increased risk of developing diabetes? SUMMARY ANSWER: The study provides evidence that male factor infertility may predict later occurrence of diabetes mellitus with the risk being related to the severity of the underlying fertility problem. WHAT IS KNOWN ALREADY: Previous cross-sectional studies have shown an increased prevalence of comorbidities among infertile men when compared to controls. STUDY DESIGN, SIZE, DURATION: In this prospective cohort study, 39 516 men who had since 1994 undergone fertility treatment with their female partner were identified from the Danish national IVF register, which includes data on assumed cause of couple infertility (male/female factor, mixed and unexplained infertility) and type of fertility treatment. With a median follow-up time of 5.6 years, each man was followed for diabetes occurrence from enrollment until 31 December 2012 using the National Diabetes Register (NDR). Men with a history of diabetes prior to their fertility diagnosis were excluded. Hazard ratios (HR) were estimated by Cox proportional hazard models with age as the underlying time scale. In addition to analyzing the data for the entire IVF registration period (1994-2012), separate analyses were performed for men identified from the first (1994-2005) and second (2006-2012) IVF registration period owing to heterogeneity in the reporting of male factor infertility in these two time periods, because the reason for male factor infertility was not available from the first register. PARTICIPANTS/MATERIALS, SETTING, METHODS: Male factor infertility was identified from the variable 'yes' or 'no' from the first IVF register and through a diagnosis code (e.g. oligospermia, azoospermia) from the second IVF register. The reference group was men with male factor infertility (='no') and those with normal semen quality or sterilized men. Of the included men, 18 499 (46.8%) had male factor infertility and 21 017 (53.2%) made up the reference group. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 651 (1.6%) diabetes cases were identified during the follow-up period. The adjusted HR's for diabetes risk among men with male factor infertility when compared to the reference group were HR = 1.08 (95% CI: 0.89, 1.31) and HR = 1.45 (95% CI: 1.06, 1.97) for the first and second IVF registration period, respectively. When assessing the effects of individual causes of male factor infertility, the adjusted HR's for men with oligospermia, azoospermia and aspermia were HR = 1.44 (95% CI: 1.01, 2.06), HR = 2.10 (95% 1.25, 3.56) and HR = 3.20 (95% CI 1.00, 10.31), respectively. LIMITATIONS, REASONS FOR CAUTION: We found no increased risk among men identified from the first IVF register, which may be related to exposure misclassification as the reason for male factor infertility was not available from this time period. The NDR does not distinguish between type 1 and type 2 diabetes. WIDER IMPLICATIONS OF THE FINDINGS: These findings support previous studies that a man's reproductive and somatic health are closely intertwined and highlight the importance for further monitoring of these men. Further, implementation of diabetes screening may be especially relevant among aspermic and azoospermic men. STUDY FUNDING/COMPETING INTERESTS: This article is part of the ReproUnion collaborative study, co-financed by the European Union, Intereg V Öresund-Kattegat-Skagerrak. None of the authors declare any conflict of interest. TRIAL REGISTRATION NUMBER: None.

Management of the dry ejaculate: a systematic review of aspermia and retrograde ejaculation.

A dry ejaculate (aspermia), may occur either because of an inability to transport semen (anejaculation) or because of an inability to ejaculate in an antegrade direction (retrograde ejaculation). The treatment of aspermia varies with underlying etiology and includes medical therapy with sympathomimetics, urinary sperm retrieval, bladder neck reconstruction, prostatic massage, penile vibratory stimulation, electroejaculation, and surgical sperm retrieval. A systematic review of the current literature was performed for articles on ejaculatory dysfunction related to dry ejaculate. However, the data are insufficient to allow firm comparisons between treatment options. Treatments must be tailored to the individual patient, and treatment decisions should involve consideration of ease of administration, degree of invasiveness, and anticipated success.

Pregnancy outcome according to male diagnosis after ICSI with non-ejaculated sperm compared with ejaculated sperm controls.

The aim of this study was to describe pregnancy outcome in couples who had undergone ICSI using non-ejaculated sperm from men with non-obstructive azoospermia, obstructive azoospermia and aspermia compared with the outcome of ICSI with ejaculated sperm from men with severe oligozoospermia, treated during the same time period. This nationwide cohort study included all children born after ICSI with non-ejaculated sperm in Norway, from when the method was first permitted in Norway in April 2004 to the end of 2010, resulting in 420 pregnancies and a total of 359 children. In 235 of these children, the father was diagnosed with obstructive azoospermia, in 72 with non-obstructive azoospermia, in 31 with aspermia, and in 21 the male cause was unclassifiable. The control group consisted of 760 children from 939 pregnancies conceived by ICSI with ejaculated sperm. Sex ratio, birth weight, rate of pregnancy loss and congenital malformations were not significantly associated with sperm origin or the cause of male factor infertility.

Male and female factors that influence ICSI outcome in azoospermia or aspermia.

Factors that influenced the clinical results of 220 first-attempt intracytoplasmic sperm injection (ICSI) cycles with testicular spermatozoa were evaluated in 107 men with non-obstructive azoospermia, 72 with obstructive azoospermia and 41 with aspermia. Linear and logistic regression analysis showed that the fertilization rate depended positively on Johnsen score (P = 0.016) and on the type of ovarian stimulation: a higher fertilization rate was observed after ovarian stimulation with agonist and recombinant FSH than after stimulation with agonist and urinary menopausal gonadotrophin (P = 0.026). Embryo development to the blastocyst stage was predicted positively by the number of injected oocytes (P = 0.016) and negatively by male FSH concentration (P = 0.019). A higher proportion of blastocysts developed after the use of frozen-thawed spermatozoa in comparison to fresh spermatozoa (P = 0.034). Embryo development to the blastocyst stage influenced pregnancy (P = 0.002) and live birth outcomes (P = 0.005); live birth was also predicted by female age (P = 0.046). Embryo culture to day 5 in comparison to day 2 did not provide higher live birth rates. In azoospermia/aspermia, the ICSI outcome depends on both male factors (FSH, Johnsen score, sperm status and motility) and female factors (age, number of injected oocytes).