Antibiotic usage in surgical sperm retrievals among IVF centers

Surgical sperm retrieval(SSR)is currently one of the most common procedures in in vitro fertilization(IVF).However,a gap between the guidelines and routine clinical practice regarding antibiotic use in sSR,which might lead to antibiotic resistance,is a challenging problem worldwide.A cross-sectional survey was conducted from May 1,2021,to July 15,2021,to investigate antibiotic usage by medical professionals when performing SSR in IVF centers in Vietnam.The confidential questionnaire comprised 12 items,including characteristics of the study population,awareness of antimicrobial resistance,attitude toward prescribing antibiotics,and current practice of prescribing antibiotics when performing SSR.Surveys were completed by 30 of 45 registered IVF centers(66.7%).Among 67 physicians working at those centers,the age and work-experience years(mean±standard deviation[s.d.])were 38.6±6.6 years and 11.2±7.0 years,respectively.Over 60%of them held a degree in Obstetrics and Gynecology,and over four-fifths were men.Most respondents"often/very often/always"raised awareness of antimicrobial resistance to their patients(83.3%),but only half of them"often/occasionally"prescribed antibiotics to patients with SSR in cases where the prescription would be optional.About one-tenth of respondents followed the recommendation from the American Urological Association using"prophylaxis only"for SSR patients.For more invasive SSR,physicians tended to prescribe more complicated and sometimes inappropriate regimens.In conclusion,antibiotic usage in SSR was not always appropriate among IVF centers.Further studies may define specific recommendations for regimens,intervention strategies,and programs to promote appropriate antibiotic use for SSR patients among IVF specialists.

Vlale sexual dysfunction and infertility associated with neurological disorders

Normal sexual and reproductive functions depend largely on neurological mechanisms. Neurological defects in men can cause infertility through erectile dysfunction, ejaculatory dysfunction and semen abnormalities. Among the major conditions contributing to these symptoms are pelvic and retroperitoneal surgery, diabetes, congenital spinal abnormalities, multiple sclerosis and spinal cord injury, Erectile dysfunction can be managed by an increasingly invasive range of treatments including medications, injection therapy and the surgical insertion of a penile implant. Retrograde ejaculation is managed by medications to reverse the condition in mild cases and in bladder harvest of semen after ejaculation in more severe cases. Anejaculation might also be managed by medication in mild cases while assisted ejaculatory techniques including penile vibratory stimulation and eiectroejaculation are used in more severe cases. If these measures fail, surgical sperm retrieval can be attempted. Ejaculation with penile vibratory stimulation can be done by some spinal cord injured men and their partners at home, followed by in-home insemination if circumstances and sperm quality are adequate. The other options always require assisted reproductive techniques including intrauterine insemination or in vitrofertilization with or without intracytoplasmic sperm injection. The method of choice depends largely on the number of motile sperm in the ejaculate.

Advances in the management of infertility in men with spinal cord injury

Couples with a spinal cord injured male partner require assisted ejaculation techniques to collect semen that can then be further used in various assisted reproductive technology methods to achieve a pregnancy. The majority of men sustaining a spinal cord injury regardless of the cause or the level of injury cannot ejaculate during sexual intercourse. Only a small minority can ejaculate by masturbation. Penile vibratory stimulation and electroejaculation are the two most common methods used to retrieve sperm. Other techniques such as prostatic massage and the adjunct application of other medications can be used, but the results are inconsistent. Surgical sperm retrieval should be considered as a last resort if all other methods fail. Special attention must be paid to patients with T6 and rostral levels of injury due to the risk of autonomic dysreflexia resulting from stimulation below the level of injury. Bladder preparation should be performed before stimulation if retrograde ejaculation is anticipated. Erectile dysfunction is ubiquitous in the spinal cord injured population but is usually easily managed and does not pose a barrier to semen retrieval in these men. Semen analysis parameters of men with spinal cord injury are unique for this population regardless of the method of retrieval, generally presenting as normal sperm concentration but abnormally low sperm motility and viability. When sperm retrieval is desired in this population, emphasis should be placed on initially trying the simple methods of penile vibratory stimulation or electroejaculation before resorting to more advanced and invasive surgical procedures.