Differences in seminal parameters in specimens collected via intercourse and incomplete intercourse (coitus interruptus)

To the Editor: Planned Parenthood Federation of America has been instrumental in preserving the reproductive health of women for decades. We thank Leslie Kantor1 for clarifying the situations that Planned Parenthood and others recognize in which coitus interruptus is a viable option for contraception. At the level of the individual and the couple, the social contexts described by Kampton for practicing coitus interruptus to prevent unwanted or unplanned pregnancy are indeed very reasonable. Coitus interruptus, however, does not protect women from acquiring sexually transmitted infections (STIs) that can often be asymptomatic. In Wave III of the National Longitudinal Survey of Adolescent Health (Add Health), 95% of respondents with chlamydial infection reported no symptoms in the previous 24 hours.2 Left untreated, chlamydial and gonococcal infections place women at risk for infertility, pelvic inflammatory disease, tubal-ovarian abscesses, ectopic pregnancies, and increased susceptibility to HIV infection.3 Furthermore, reliance on coitus interruptus has important implications, at the level of the sexual network and the general population.4,5 Multiple partnerships, concurrent partnerships, or nonmonogamous partners comprise features of sexual networks that accelerate and amplify the spread of STIs. For the populations that experience disproportionate incidence of STIs or for whom unplanned or unwanted pregnancy may be a deleterious consequence, promoting dual use of condoms and hormonal contraception and dissuading use of withdrawal whenever possible reduces the strain on already woefully inadequate public health resources. Irene A. Doherty, PhD, MPH Department of Medicine Division of Infectious Diseases School of Medicine University of North Carolina Chapel Hill, NC Gretchen S. Stuart, MD, MPHTM, FACOG Department of Obstetrics and Gynecology School of Medicine University of North Carolina Chapel Hill, NC

The main purpose of this project is to verify whether there is a difference in the expression of aryl hydrocarbon receptor (AhR) between varicocele (VC) and normal male semen, and determine whether there is a connection with the parameters of semen analysis. The risk factors of infertility in patients with VC were also studied. Semen samples were collected for semen analysis and Western blot. Logistic regression was used to investigate the risk factors associated with infertility in patients with VC. Men with VC had lower AhR expression compared to healthy men; correlation analysis results showed that: AhR expression in patients with VC group was significantly positively correlated with sperm concentration and sperm motility; significantly negatively correlated with the diameter of spermatic veins during Valsalva and the percentage of abnormal sperm morphology; the research results of related risk factors show that the risk of infertility of patients with grade III is 1.67 times that of patients with grades I and II. For each unit of abnormal sperm morphology, the risk of infertility increases 1.04 times. Sperm concentration, total sperm viability and each unit the expression of AhR protein decreases the risk of infertility by 3%, 9% and 11% respectively.

Clinical guidelines for sperm cryopreservation in cancer patients

BackgroundMisconceptions about the usefulness of condoms and other contraceptives still expose many unmarried adolescents to the risk of unwanted teenage pregnancies and sexually-transmitted infections (STIs). This study explored beliefs and misconceptions about condoms and other contraceptives among adolescents in Ebonyi state, south-east Nigeria.MethodA qualitative study was undertaken in six local government areas in Ebonyi state, southeast Nigeria. Data were collected within a period of one month from in and out-of-school adolescents aged 13–18 years using twelve focus group discussions (FGD). The data were analyzed using the thematic framework approach.ResultMajority of the adolescents were knowledgeable about methods of contraception, how they are used and their modes of action. They were also knowledgeable about the dual effects of condoms in prevention of pregnancy and STIs. However, some misconceptions that were expressed by some adolescents were that pregnancy could be prevented by the use of (i) hard drugs, (ii) laxatives, (iii) white chlorine, and (iv) boiled alcoholic beverages. Condoms were described by some adolescent boys as reusable. Condoms were also perceived by some adolescents to reduce sexual pleasure, and this opinion was mostly held by boys. Coitus interruptus (withdrawal method) was therefore considered more preferable than condoms for prevention of pregnancy.ConclusionAlthough majority adolescents have knowledge about contraception and condom use, some misconceptions still persist. These misconceptions put many adolescents at increased risk for pregnancy and STIs which are detrimental to their health and wellbeing. Concerted efforts should be made through educational and behaviour change interventions in schools and within communities to debunk persisting misconceptions about contraception including the use of condom, and properly educate adolescents on safe sex practices.Plain English summaryAdolescents engage in unprotected sexual intercourse and other risky sexual behaviours because of some mistaken beliefs and wrong impressions about how to prevent unwanted pregnancy. These risky sexual behaviours predispose adolescents to sexually transmitted infections, unsafe abortion and other reproductive health problems.In this qualitative study, we explored some of these mistaken beliefs about condoms and other methods of preventing pregnancy. During focus group discussions, adolescents identified modern contraceptive methods, and described their modes of action and how they are used. They also discussed their contraceptive preferences and perceived effects of condoms on sexual pleasure.Although some of these adolescents were able to correctly mention various types of contraceptives and their modes of action, there were numerous wrong impressions. Hard drugs, laxatives, white chlorine and boiled alcoholic beverage were listed as emergency contraceptive methods. Emergency pills were perceived to work by flushing away spermatozoa from a girl’s system after sexual intercourse. Male condoms were perceived to be potentially dangerous because they could break and enter into the body of the female sexual partner. Some adolescent boys had the notion that particular brands of male condoms could be washed and reused. Notions about condom use and sexual pleasure varied for girls and boys. Some adolescent girls perceived that condom use during sex increases sexual pleasure because of the assurance of being protected from STIs and pregnancy. Adolescent boys were of the opinion that condoms interfere with the pleasure of direct ‘flesh to flesh’ contact during sex. There was a general belief that contraceptive use in early age reduces fertility prospects for boys and girls.Mistaken beliefs about methods of preventing pregnancy persist among adolescents, and this raises concerns about the quality of information they receive. Concerted efforts should be made to debunk these wrong beliefs and properly educate adolescents on safe sex practices.

As one of the treatment for infertility, the success rate of Intrauterine Insemination (IUI) is still relatively low. Several sperm preparation methods, swim-up (SU) and the density-gradient centrifugation (DGC) are frequently used to select for better sperm quality which also contribute to IUI failure. Sperm selection methods mainly separate the motile from the immotile sperm, eliminating the seminal plasma. The sperm motility involves the structure and function of sperm membrane in maintaining the balance of ion transport system which is regulated by the Na+, K+-ATPase, and Ca2+-ATPase enzymes. This study aims to re-evaluate the efficiency of these methods in selecting for sperm before being used for IUI and based the evaluation on sperm Na+,K+-ATPase and Ca2+-ATPase activities. Fourteen infertile men from couples who underwent IUI were involved in this study. The SU and DGC methods were used for the sperm preparation. Semen analysis was performed based on the reference value of World Health Organization (WHO) 2010. After isolating the membrane fraction of sperms, the Na+, K+-ATPase activity was defined as the difference in the released inorganic phosphate (Pi) with and without the existence of 10 mM ouabain in the reaction, while the Ca2+-ATPase was determined as the difference in Pi contents with and without the existence of 55 µm CaCl2. The prepared sperm demonstrated a higher percentage of motile sperm compared to sperm from the whole semen. Additionally, the percentage of motile sperm of post-DGC showed higher result than the sperm from post-SU. The velocity of sperm showed similar pattern with the percentage of motile sperm, in which the velocity of prepared sperm was higher than the sperm from whole semen. Furthermore, the sperm velocity of post-DGC was higher compared to the sperm from post-SU. The Na+, K+-ATPase activity of prepared sperm was higher compared to whole semen, whereas Na+, K+-ATPase activity in the post DGC was higher than post SU. The Ca2+-ATPase activity of prepared sperm was higher compared to whole semen, whereas Ca2+-ATPase activity in the post DGC was higher than post SU. The SU and the DGC methods were able to perform sperm selection by showing a high result of Na+, K+-ATPase and Ca2+-ATPase activities, moreover DGC method selected the sperm with high activities of both the Na+, K+-ATPase and Ca2+-ATPase better compared to SU method.As one of the treatment for infertility, the success rate of Intrauterine Insemination (IUI) is still relatively low. Several sperm preparation methods, swim-up (SU) and the density-gradient centrifugation (DGC) are frequently used to select for better sperm quality which also contribute to IUI failure. Sperm selection methods mainly separate the motile from the immotile sperm, eliminating the seminal plasma. The sperm motility involves the structure and function of sperm membrane in maintaining the balance of ion transport system which is regulated by the Na+, K+-ATPase, and Ca2+-ATPase enzymes. This study aims to re-evaluate the efficiency of these methods in selecting for sperm before being used for IUI and based the evaluation on sperm Na+,K+-ATPase and Ca2+-ATPase activities. Fourteen infertile men from couples who underwent IUI were involved in this study. The SU and DGC methods were used for the sperm preparation. Semen analysis was performed based on the reference value of World Health Organizatio...

ABSTRACTWe investigated the impact of prior anticancer treatments such as chemotherapy and radiotherapy on subsequent infertility treatment in cancer survivors who consulted our male infertility division. Of 1,525 male infertility patients who consulted our division between 2008 and 2018, 56 (3.7%) were cancer survivors. Of these, 32 received anticancer treatment (group A) and 24 were treated with surgery alone or were seen before anticancer treatment (group B). Semen analysis revealed that azoospermia in 26 subjects (81.3%) and 14 (58.3%) in groups A and B respectively. Ejaculatory dysfunction was observed 1 in group A and in 2 group B subjects. Sperm cryopreservation before anticancer treatment was performed 4 subjects. Sperm retrieval surgery for intracytoplasmic sperm injection (ICSI) was performed in 13 cases in group A and 10 in group B. Motile sperm were recovered in 7 subjects and in 8 subjects in group A and B respectively. Overall pregnancies and deliveries with ICSI were achieved for 7 subjects (21.9%) in group A, and 9 (37.5%) in group B. Successful sperm retrieval may not be affected by prior anticancer treatment as shown in this study. However, some patients abandoned infertility treatment due to the cost of testing and sperm retrieval surgery. Support for the cost of infertility treatment in cancer survivors is necessary.

Infertility affects 1 in 6 couples, yet male fertility assessments often rely on semen analysis alone, which has limited predictive value for treatment success. This study evaluates an epigenetic tool for assessing sperm quality, aiming to provide a more comprehensive view of male fertility and improve personalized treatment strategies. De-identified pregnancy outcomes from 537 couples treated at 10 US fertility clinics were analyzed. Partner ages, total motile sperm count, treatment type, and sperm epigenetic quality were considered to assess associations with fertility treatment outcomes. Men with abnormal sperm epigenetic profiles had significantly lower pregnancy success rates with intrauterine insemination (IUI) compared to those with normal profiles, despite similar sperm motility and concentration. In contrast, pregnancy rates did not differ between abnormal and normal profiles among couples undergoing in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI), suggesting that ICSI may overcome sperm epigenetic quality issues. This real-world analysis was limited by the availability of detailed clinical and phenotypic data, which may introduce potential confounders. Nevertheless, the findings highlight the clinical value of epigenetic sperm assessment as part of male fertility evaluation and support its potential to guide more effective, personalized fertility treatment pathways.

Background: Every married couple hopes to have children, but not all can fulfil that desire. A married couple finds themselves unable to achieve pregnancy after 12 months of regular unprotected sexual intercourse, which can be called infertility. Infertility can also occur in men. In dealing with infertility, intrauterine insemination (IUI) is a cost-effective and non-invasive Assisted Reproductive Technology (ART) procedure. The condition of male infertility can be detected through semen analysis. One of the parameters in semen analysis is the total motile sperm count (TMSC). Objective: This research seeks to establish the relationship between post-preparation TMSC and the success rate of the IUI procedure. Methods: This research adopts a descriptive-analytical design employing a cross-sectional methodology. Non-probability sampling was utilized as the sampling technique, and the data analyzed were secondary data from the medical records of male patients aged 25 to 45 years old diagnosed with infertility. The subjects had undergone IUI at Rumah Sakit Kasih Ibu Denpasar from January 1 to December 31, 2022. Results: From the 35 obtained samples, 12 individuals (34.3%) had a post-preparation TMSC of ≥10 × 106, while 23 individuals (65.7%) had a post-preparation TMSC of <10 × 106. The success rate of the Intrauterine Insemination (IUI) procedure was 17.1%, with 4 couples (33.3%) having a post-preparation TMSC of ≥10 × 106 and 2 couples (8.7%) with a post-preparation TMSC of <10 × 106. The Fisher's Exact test carried out has obtained a result (p=0.151), while the value of the odds ratio (OR) obtained (OR=5.250) Conclusion: Based on statistical analysis, it can be concluded that there is no significant association between post-preparation TMSC in infertile men and the success rate of IUI procedures (p > 0.05). The odds ratio (OR) obtained is 5.250 (95% CI 0.799-34.496).

Background: Until now the existing male contraceptive methods are periodic abstinence, interrupted intercourse (coitus interruptus), the use of condoms, and vasectomy. Another alternative method of contraception for men is the use of the hormone depot medroxyprogesterone acetate (DMPA) as has been done in female contraceptives. Research with DMPA at a dose of 1.25 mg was effective in reducing the concentration and viability of spermatozoa and testosterone secretion in male rats.
 Aim: to discover if DMPA as a gonadotropin hormon could effectively inhibit the process of spermatogenesis in male mice.
 Methods: This research is an experimental research with post-test control group design. A total of 36 samples were grouped by simple random sampling into two groups. Control group (P0): consisted of 18 male mice given 0.3 ml of intramuscular aquabides. Treatment group (P1): 18 male mice were given DMPA intramuscularly (IM) with a dose of 3 mg as much as 0.3 ml. Data obtained from examination of the mean of 60 tubules (30 tubules from the right testis and 30 tubules from the left testis) for each treatment with HE staining at 400x magnification.
 Results: The results showed a significant difference in the decrease in the number of spermatogonia cells in the treatment group compared to the control group (9.83±2.33 vs 12.78±1.67 cells/tubule), with p value = 0.000 (p<0.01) and Spermatid cells (76.50±7.66 vs 86.44±6.06 cells/tubule), with p value = 0.000 (p<0.01). The administration of DMPA could significantly reduce the number of spermatogonia and spermatid cells in the seminal tubules of male mice.
 Conclusion: The results of the study have implications for further research on the use of DMPA as a male contraceptive in higher experimental animals such as rabbits, then clinical trials in humans.

The world population, currently estimated to be over six billions, is expected to double in the next forty years. The projected growth will cause severe over crowding that will have an adverse effect on the ecological health of the planet. A recent survey by the United Nations found that a majority of men in many countries are willing to participate in family planning by taking full control of their fertility. However, the available contraceptives for men have either higher failure rates or they are irreversible. Thus, the contraceptive needs of tens of millions of men go unmet every day resulting in millions of unwanted pregnancies, and hundreds of thousands of abortions. Since the introduction of oral contraceptive (pill) for women over five decades ago, there have been numerous collaborative efforts by scientists and pharmaceutical companies to improve the effectiveness and delivery of contraceptives to women who wish to safely regulate their reproductive physiology. However, the contraceptive options available to men have not changed in several decades and are still limited to the use of condoms and timely withdrawal (coitus interruptus) or under going a minor surgical procedure (vasectomy) that prevents the release of spermatozoa during ejaculation. The first two methods have relatively higher typical-use failure rates, whereas the last approach is largely irreversible and not suitable for younger men. Despite non-stop efforts worldwide, we may still be several years away from providing safe, effective and affordable male contraceptives which will allow both men and women to participate fully in family planning. In this article, we will discuss various contraceptives currently available to regulate male fertility. In addition, we will summarize potentially new contraceptives for men that are at various stages of research and development. Finally, our intention is to discuss details of two safe, reversible and affordable male contraceptive approaches that are inching closure to being approved for use by the masses in India and China, the world's two most populous nations.

Intra-uterine insemination for unexplained subfertility.

Propecia may induce spermatogenic failure

Increase in adolescent sexual activity is a phenomenon noticed in modern societies, as well as in Serbia. The sexual activity reveals new health related problems, in relation to the unpremeditated pregnancies and sexually transmitted diseases. Reproductive health is vulnerable especially in case of persons having first sexual experiences being adolescent, what could be explained by the physical immaturity and psychosocial infirmity to be responsible in sexual behaviour. The study of 300 sexually active adolescent women aged 19, attending The Youth Advisory Center of The Mother and Child Health Care Institute of Serbia was conducted between 1995 - 1997. The aim of this study was to evaluate how much the reproductive health in this population was endangered, by analyzing their sexual behavior, their attitudes in the spheres of sexuality and reproduction, as well as some variables of social microenvironments that might be relevant to adolescent sexual behavior. Questionnaire included investigation of youth opinion about some acceptable social measures in this field. According to the results of this study the adolescents reproductive health is seriously endangered. Interwieved adolescent females most frequently used traditional birth control methods, like coitus interruptus (54,3%), and often didn't think about the risk of acquiring sexually transmitted disesase (with new sexual partner the regular condom use was reported only in case of 55,6% girls). Adolescent girls had also poor health behaviors so that 31,0% of interviewed adolescent females visited gynecologist for the first time not earlier than one to three years after their first sexual experience. That resulted in large number of unplanned pregnancies (16,0% of interwieved girls had one or more induced abortions) and, possibly, a high prevalence of sexually transmitted infections. The model of sexual behavior, that was accepted by adolescent females was partly due to the lack of adolescents knowledge about sexuallity, contraception and sexually transmitted diseases. Improper were the main sources of relevant knowledge (peers, parents, mass media), therefore, youth had many misconceptions in this sphere (about the harmfulness of modern contraception, reliability of coitus interruptus method, lack of risk for sexually transmitted diseases transmission). The social adolescent sexual and reproductive health programme doesn't exist in Serbia. Parents of adolescent females were passive, and school and health care workers are not engaged in these matters enough. The possibility for social intervention programme exists, because young people were willing to improve their knowledge about sexuality and reproduction (83,3%) mostly by sex education in schools (51,0%) and through mass media (33,3%). The most appreciated sources of relevant knowledge would be physicians (67,0%), from whom they expect to have time and patience for them and their problems (91,3%).

Novel technologies for selecting the best sperm for in vitro fertilization and intracytoplasmic sperm injection

Induction of superovulation with gonadotropins and intrauterine insemination are frequently used to treat infertility. We conducted a large, randomized, controlled clinical trial of these treatments. We studied 932 couples in which the woman had no identifiable infertility factor and the man had motile sperm. The couples were randomly assigned to receive intracervical insemination, intrauterine insemination, superovulation and intracervical insemination, or superovulation and intrauterine insemination. Treatment continued for four cycles unless pregnancy was achieved. The 231 couples in the group treated with superovulation and intrauterine insemination had a higher rate of pregnancy (33 percent) than the 234 couples in the intrauterine-insemination group (18 percent), the 234 couples in the group treated with superovulation and intracervical insemination (19 percent), or the 233 couples in the intracervical-insemination group (10 percent). Stratified, discrete-time Cox proportional-hazards analysis showed that the couples in the group treated with superovulation and intrauterine insemination were 3.2 times as likely to become pregnant as those in the intracervical-insemination group (95 percent confidence interval, 2.0 to 5.3) and 1.7 times as likely as those in the intrauterine-insemination group (95 percent confidence interval, 1.2 to 2.6). The couples in the intrauterine-insemination group and in the group treated with superovulation and intracervical insemination were nearly twice as likely to conceive as those in the intracervical-insemination group. Among infertile couples, treatment with induction of superovulation and intrauterine insemination is three times as likely to result in pregnancy as is intracervical insemination and twice as likely to result in pregnancy as is treatment with either superovulation and intracervical insemination or intrauterine insemination alone.