Diagnosis and treatment of infertile men: a clinical perspective

Genital infection in males with idiopathic infertility

We investigated a group of male patients with idiopathic infertility to determine the presence of genital infection and to identify the pattern of this infection using a specially designed protocol. A prospective study was carried out on 63 patients and 23 controls. We cultured the first voided urine, semen and swabs taken from the anterior urethra of these patients and controls for bacteria, chlamydia. Ureaplasma urealyticum and Mycoplasma hominis. Two techniques were used for chlamydial isolation and identification. These involved the use of chlamydial culture on McCoy cells with culture confirmation test and the direct fluorescent identification of Chlamydiatrachomatis. The all-liquid media (MYCOFAST ALL-IN) kits were used for the identification of mycoplasma. Our results indicate that there is a significantly higher incidence of genital infection among male patients with idiopathic infertility than in normal fertile controls (P=0.0004). Extensive microbial investigations are indicated when genital infection is suspected to be the cause of the fertile state or cannot be ruled out as a possible cause in case of idiopathic infertility.

Varicocele vein ligation in 565 patients under local anesthesia: a long-term review of technique, results and complications in light of proposed management by laparoscopy

Several recent reports have suggested that laparoscopic internal spermatic vein ligation provides a simpler, less debilitating and more cost efficient method of varicocele ligation than conventional surgical techniques. We analyzed the results of open varicocele ligation using local anesthesia in 565 patients for 10 years. All surgery was performed in the outpatient setting using 0.5% lidocaine. In most patients 50 to 200 mcg. fentanyl or 3 to 7 mg. midazolam were used for intravenous sedation. The average operating time, including the administration of anesthesia, was 39 minutes for unilateral and 71 minutes for bilateral procedures. All patients returned to light duty work in 24 to 48 hours and full strenuous physical activity within 1 week. The only complications encountered were 2 wound hematomas (0.3%), 4 minor wound separations (0.7%) and 41 hydroceles (7.3%). Semen improvement and pregnancy rates were similar to those reported in prior series. This study demonstrates that varicocele vein ligation can be done rapidly, efficiently and safely using local anesthesia with time of recovery and return to work comparable to those reported for laparoscopic techniques.

Ten years of experience with semen cryopreservation by cancer patients: follow-up and clinical considerations

Antineoplastic damage to the testicular germinal epithelium with accompanying infertility or subfertility is now a recognized indication for the use of sperm banking. Thus, issues concerning quality of life now compete with questions of survival in decisions made in oncologic settings. In an attempt to learn what concerns patients who use semen preservation facilities, a 10-year retrospective study was undertaken. Registered mail and phone solicitation was used to determine follow-up characteristics of self-referred male cancer patients who voluntarily banked semen at a private facility before they began cancer treatment. The difficulties encountered in conducting follow-up on this group of patients raise questions about sperm banking practices by cancer populations.