The office management of ejaculatory disorders

Can We Clinically Distinguish Anejaculation From Retrograde Ejaculation in Patients on α1A-Blockers Therapy for Lower Urinary Tract Symptoms?

OBJECTIVE

To investigate the physiopathology of ejaculatory disorders (EjD) and discriminate between retrograde ejaculation (REj) and anejaculation (AEj) induced by α1A-blockers, through the association between the mean postorgasm seminal vesicle volume and the presence of sperm in midstream urine, in patients with moderate-to-severe lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement.

MATERIALS AND METHODS

Therapy-naïve male patients with LUTS and without previous EjD were treated with α1A-blockers. Pre- and post-treatment EjD were investigated through question 4 of the 4-item Male Sexual Function questionnaire and the Male Sexual Health Questionnaire for Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF). After 12 weeks, postorgasm urine was collected for sperm count and seminal vesicle volume was calculated through transrectal ultrasound.

RESULTS

All 42 patients reported with EjD after treatment with α1A-blockers: 4-item Male Sexual Function questionnaire and MSHQ-EjD-SF Q4 scores were significantly higher (P <.001) and MSHQ-EjD-SF Q1-3 score was significantly lower (P <.001) than before. Postorgasm seminal vesicle volume was significantly higher in patients with postorgasm sperm-negative urine (AEj), and lower in patients with postorgasm sperm-positive urine (REj; P <.001).

CONCLUSION

We clearly demonstrated an association between the presence of sperm in the midstream urine and seminal vesicle volume after orgasm, strongly confirming and differentiating the hypothesis of a dual etiology for EjD (REj vs AEj) secondary to α1A-blockers therapy for LUTS.

Assisted reproductive technology in Beijing, 2013-2015

RESEARCH QUESTION

Why are comprehensive and detailed reports of local or national utilization outcomes of assisted reproductive technology (ART) lacking in China?

DESIGN

Retrospective collection of data on intrauterine insemination (IUI) and IVF and intracytoplasmic sperm injection (ICSI) in Beijing, including all 12 registered institutions with cycles, started between 1 January 2013 and 31 December 2015.

RESULTS

Clinical pregnancy rates (CPR) per aspiration and fresh embryo transfer were 39.1% and 43.2% in 2013, 40.1% and 45.4% in 2014, and 37.8% and 44.5% in 2015; live birth rates (LBR) per aspiration and per fresh embryo transfer were 31.7% and 35.0%, 32.3% and 36.6%, and 30.3% and 35.6%, respectively. In frozen embryo transfer (FET) cycles, the CPR per thawed transfer was 43.4%, 47.2% and 46.2%, respectively, resulting in LBR of 34.3%, 37.4% and 36.5%. The prevalence of multiple pregnancies was 28.0-31.3% for fresh embryo transfer, and 23.5-25.9% for FET. The LBR was 8.8-9.1% after IUI with husband or partner's semen (IUI-H), and 16.7-19.7% after IUI with donor semen (IUI-D). The birth defect rate among live born infants was 1.52%, 0.42% and 0% after IUI-H, 1.05%, 0.39% and 0.66% after IUI-D, 0.71%, 0.56% and 0.46% after fresh embryo transfer, and 0.73%, 0.20% and 0.18% after FET in 2013, 2014 and 2015, respectively.

CONCLUSIONS

In Beijing over 3 years, the number of IVF-ICSI cycles has increased and the number of IUI cycles has decreased; IVF-ICSI outcomes are better and safer. Further effort should be made to lower the multiple pregnancy rates. A Chinese nationwide ART registry should be promoted.