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The achievement of pregnancies using assisted reproductive technologies for male factor infertility after
L S Hakim1, S M Lobel, R D Oates
1Department of Urology, Boston University School of Medicine, Massachusetts 02118, USA.
Objective:
To evaluate the success of electroejaculation with assisted reproductive technologies (ART) in anejaculate men after retroperitoneal lymph node dissection (RPLND) for testicular cancer.
Design:
Retrospective clinical study.
Setting:
Tertiary care, university-affiliated IVF program.
Patients:
Anejaculate men after RPLND, spouses.
Interventions:
Electroejaculation, microsurgical sperm aspiration, various assisted reproductive technologies.
Main Outcome Measures:
Sperm density and motility, fertilization rate, pregnancy rate (PR).
Results:
Compared with patients not receiving chemotherapy, patients who received chemotherapy had diminished average sperm densities and motilities (63 x 10(6) and 20% versus 101 x 10(6) 32%, respectively); decreased fertilization rates per cycle for IVF and intracytoplasmic sperm injection (ICSI) (11% versus 26%, respectively); lower PRs per cycle of hMG-IUI and IVF (14% versus 60% and 8% versus 50%, respectively). No pregnancies were achieved with natural cycle-IUI, clomiphene citrate-IUI, or GIFT. Two couples progressed to intracytoplasmic sperm injection with one achieving the successful delivery of healthy twins. The overall PR per cycle was 22%.
Conclusions:
Patients receiving chemotherapy had decreased sperm densities, motilities, fertilization, and PRs for each modality used. Rectal probe electroejaculation with ART can help anejaculate men after RPLND achieve biologic paternity. An early move to the more aggressive therapies (hMG-IUI, IVF, ICSI) is supported.