New Treatment For Common Cause Of Male Infertility

Researchers in Germany found that a simple and minimally invasive outpatient treatment for varicoceles, a common cause of male infertility that affects about 1 in 10 men, can significantly improve sperm function and pregnancy rates.

The study came from the University of Bonn Medical School and is published in the August issue of Radiology.

Lead author Dr Sebastian Flacke and colleagues found that the level of sperm motility present before having the treatment was also an important predictor of pregnancy success.

Flacke is now an associate professor of radiology at the Tufts University School of Medicine, director of noninvasive cardiovascular imaging and vice chair for research and development in the department of radiology at the Lahey Clinic in Burlington, Massachusetts.

He said that:

"Venous embolization, a simple treatment using a catheter through the groin, can help to improve sperm function in infertile men."

"With the patients' improved sperm function, more than one-quarter of their healthy partners were able to become pregnant," added Flacke.

Varicoceles is a condition like varicose veins where the blood vessels in the scrotum become tangled and swollen. Normally the blood flows from the testicles back to the heart via small veins that have a non-return valve to stop the blood flowing backwards to the testicles. But if these valves stop working, then the blood backs up, fails to leave the testicles properly and causes the vessels to bulge and swell.

Varicoceles is a common condition that generally has no symptoms or harmful side effects and affects between 10 and 15 per cent of adult men in the US. Figures from the National Institutes of Health suggest it mostly affects young men between 15 and 25. Occasionally the condition results in pain, shrinkage, or fertility problems.

Until recently, men with problematic varicoceles were treated with open surgery to remove the affected blood vessels, but now there is a minimally invasive procedure called catheter embolization which a man can have as an outpatient. Catheter embolization is where the radiologist inserts a small tube or catheter through a tiny cut in the groin, and using x-ray imaging, guides the catheter to the affected blood vessel and then blocks it using a platinum coil and a few millillitres of a liquid agent. The patient recovers quickly and is usually well enough to go back to work in 24 hours.

For this study, in order to identify what might affect pregnancy rates in couples where the man was infertile before undergoing varicocele embolization, Flacke and colleagues recruited 223 infertile men aged between 18 and 50 who had been diagnosed with at least one varicocele and who underwent embolization. All the men had healthy partners with whom they had been trying to conceive.

Before and after the procedure, all participants underwent a clinical exam (with ultrasound test), gave a semen specimen, and had their hormone levels tested.

The results showed that:226 of the patients' 228 varicoceles were successfully treated with embolization.

Follow up data was successfully obtained for 173 patients, and in these, three months after the procedure, the average sperm motility and sperm count was found to be significantly improved.

Six months later, 45 couples (26 per cent of the 173 followed up), reported a pregnancy.

The only significant pre-treatment predictor of post-treatment pregnancy success was sperm motility.

Other measures such as hormone levels, clinical grading of varicoceles, Doppler ultrasound findings, and other semen parameters did not reach statistical significance.
Flacke said:

"Embolization of varicoceles in infertile men may be considered a useful adjunct to in-vitro fertilization."

"Embolization of Varicocles: Pretreatment Sperm Motility Predicts Later Pregnancy in Partners of Infertile Men."
Sebastian Flacke, Michael Schuster, Attila Kovacs, Marcus von Falkenhausen, Holger M. Strunk, Gerhard Haidl, and Hans H. Schild.
Radiology 2008 248: 540-549.
Volume 248, Issue 2, August 2008
DOI: 10.1148/radiol.2482071675.

Singapore Airlines

A mother and her young inquisitive son were flying Singapore
Airlines from Singapore to New York.

The son (who had been looking out the window) turned to his mother
and asked, "If dogs have baby dogs and cats have baby cats, why
don't planes have baby planes?"

The mother (who couldn't think of an answer) told her son to ask the
pretty flight attendant.
So the boy dutifully asked the flight attendant, "If dogs have baby
dogs and cats have baby cats, why don't planes have baby planes?"

The flight attendant asked, "Did your mother tell you to ask me
that?" The little boy admitted that she did.

"Well, then, tell your mother that there are no baby planes because
Singapore Airlines always pulls out on time. Now, let your mother
explain that to you!!!"

How Do The Iraqis Hide From The Yanks

Expired Banks

Peanuts Forever

Malignant Conditions In Children Born After Assisted Reproductive Technology

A recent article article reviews the risks of childhood malignancies and imprinting disorders in children born as a result of assisted reproductive technology (ART) (Bibliography at the end of this post). Since the birth of Louise Brown, there have been 3 million babies born by IVF. Factors which have been implicated in potentially increasing the risk of malignancies in these offspring include:

1. gonadotropins for superovulation,
2. intracytoplasmic sperm injection,
3. blastocyst culture,
4. assisted hatching,
5. and preimplantation genetic diagnosis.

For example, whereas, a significant risk of neuroblastoma, retinoblastomas, acute lymphatic leukemia and non-Hodgkin lymphoma has been reported after ART, others have failed to replicate these findings.

Epigentic alterations leading to DNA modifications and imprinting disorders have also been implicated as a result of assisted reproductive techniques. Two genetic imprinting disorders that are known to cause birth defects and childhood malignancies, Beckwith-Wiedmann syndrome and Angelman syndrome. Each of these have been associated with ART.

The current paper provides a literature review that was unable to identify the precise risks of imprinting disorders and childhood cancers in children conceived with ART.

Although, most studies have not shown an increase in the incidence of childhood cancers after ART, patients should be advised about the known and unknown associated risks.

Neelanjana M, Sabaratnam A
Obstet Gynecol Surv. 2008 Oct;63(10):669-76

Doctors Confirm First Successful Essure Tubal Ligation Reversal

Lakeshore Surgical Center made medical history less than one year ago by being the first facility to perform an Essure Tubal Occlusion Reversal. The Essure procedure is a new type of Tubal Ligation, for women who want a permanent type of birth control or sterilization. The Essure procedure has only been performed for a little over 5 years and is reported to be permanent and NOT reversible by the manufacturing company. On November 5, 2007 Dr. William A.C. Greene Jr. and Dr. Wendell Turner at Lakeshore Surgical Center, were the first surgeons in the country to perform an Essure Reversal.

The Essure procedure differs from other Tubal Ligation due to the fact that a coil-like device is inserted into the fallopian tube where it meets the uterus. Scar tissue then grows around the inserted coil over the next 3 months to form a natural barrier that prevents sperm from reaching the egg. To reverse this procedure the doctors at Lakeshore Surgical Center developed specific instruments to allow for the Essure coil-like device to be removed with the utmost of care, and not damage the fallopian tube. Then a custom needle, designed by Dr. William Greene is used to sew the tube back into the wall of the uterus without cutting the uterus open.

The success of the procedure was confirmed October 8, 2008, by a patient who came to Lakeshore Surgical Center in March, 2008, to be one of the first women in the country to have the Essure Reversal performed by expert tubal ligation reversal surgeons, Dr. William Greene Jr. and Dr. Wendell Turner. The first Essure Reversal pregnancy has been confirmed by the patient's physician, by ultrasound and the fetal sac was seen in the uterus.

This medical procedure is a huge stepping stone in the medical field of Reproductive Surgery and Infertility. Tubal Ligation Reversals have been performed for years, but the Essure procedure, which is stated to be non-reversible, has not been successfully reversed before now. Women who want to have more children, due to divorce, loss of a child or have just changed their mind, Tubal Reversal is an option. This advance in Reproductive Surgery will allow women to be able to conceive naturally, after having the Essure procedure. In-Vitro Fertilization and other infertility treatments are no longer the only option for women who have made this choice and changed their mind.

To date Lakeshore Surgical Center has performed 4 Essure Reversals, including the case above who is now pregnant. Of these three other patients, one has yet to become pregnant, another did have a confirmed pregnancy but miscarried and the third patient has not yet become pregnant but has been seen by another physician, who confirmed through a Hysterosalpingogram (HSG) that her tubes were open.

Lakeshore Surgical Center is the leading specialized Tubal Ligation Reversal center. Located in Gainesville, GA, surgeons Dr. William A.C. Greene, Jr. and Dr. Wendell Turner have combined 50 years of outpatient gynecologic surgery experience and have performed thousands of Tubal Ligation Reversals. For 10 years, this cutting edge facility, along with the skills and expertise of its doctors and staff have provided women with the opportunity to become "pregnant again".