Seminal vesicle sperm aspiration from wounded warriors

Seminal vesicle harvest is a feasible technique for sperm retrieval in wounded warriors with extensive testicular injuries.

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Volume 106, Issue 3, Pages 579-583

Authors:

Mae Wu Healy, D.O., Belinda J. Yauger, M.D., Aidita N. James, Ph.D., James R. Jezior, M.D., Patrick Parker, D.O., Robert C. Dean, M.D.

Abstract:

Objective

To assess whether seminal vesicle sperm aspiration (SVSA) is an option for wounded warriors with severe genital and testicular injuries, with the goal of cryopreservation to use in future assisted reproductive technology (ART) cycles.

Design

Retrospective case series.

Setting

Tertiary care military hospital.

Patient(s)

Six wounded warriors.

Intervention(s)

None.

Main Outcome Measure(s)

Seminal vesicle fluid analysis after harvest, after thaw analysis, fertilization rates, pregnancy rates (PRs), live birth.

Result(s)

Six patients with lower extremity, pelvic, and genital injuries from dismounted improvised explosive devices underwent SVSA within 5–12 days of the initial injury. Sperm retrieved were analyzed (volume, 0.4–1.8 mL; concentration, 40–2,200 K; motility, 0–5%), washed, and cryopreserved. Two patients underwent IVF/intracytoplasmic sperm injection (ICSI) cycles using their samples. In one couple, fertilization rate was 38%. One grade V embryo was transferred with a negative pregnancy test. The second couple underwent two cycles. In their first cycle, fertilization rate was 44%, with one blastocyst transferred and a negative pregnancy test. In the second cycle, fertilization rate was 47%. Two blastocysts were cryopreserved due to ovarian hyperstimulation syndrome (OHSS) concerns. One blastocyst was later transferred in a frozen cycle resulting in a live birth.

Conclusion(s)

The SVSA is a reasonable option to retrieve sperm in wounded warriors or trauma patients with extensive genital injuries.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

4 Comments

Go to the profile of Edmund Ko
Edmund Ko about 4 years ago

Thank you to the brave men and women who have volunteered to put themselves in harm's way to protect our freedoms.

I do see some of these young men after they are stabilized from their initial injuries and then discharged from the military at our local VA hospital. It is devastating to me that we have good options to obtain sperm for IVF/ICSI but unfortunately the price point is oftentimes too high for the couple to afford. Because this is not a covered VA benefit, we do not offer it at that specific facility. In men that have complete destruction of their genitalia, it is reassuring to know that SV aspiration can be considered, although this study did have very small numbers. For the urologists that routinely perform transrectal US and prostate biopsies, this will come very easily and should be considered a part of the sperm retrieval armamentarium.

With the recent announcement that the government may start covering for cryopreservation of sperm and eggs, hopefully we won't have to worry about difficult retrievals.

Go to the profile of Micah J Hill
Micah J Hill about 4 years ago

Thanks for the comments Ed. We are very grateful to Rob Dean, the papers senior author, for utilizing this technique to help our wound warriors with severe lower extremity blast injuries have a chance at pregnancy. The facilities here at Walter Reed for rehabilitating these wounded warriors are phenomenal, and its great to see the reproductive medicine piece playing a role in a much larger join effort including psychiatry, orthopedics, general surgery, neurosurgery, ID, rehab medicine, ect. Every day that I go to the hospital's gym to swim, and I see the wounded soldiers working out, often with 2-3 limbs amputated. Its truly humbling and inspiring.

Currently, IVF is fully covered for wounded warriors, but not discharged veterans or soldiers who are not wounded. There is a bill before Congress to provide full coverage for all soldiers and veterans. ASRM has been a staunch advocate for our military patients. We are also involved in active discussions with the Pentagon on expanding covered reproductive services for soldiers. I think we would all agree these brave men and women deserve full coverage for their health care, including all indicated reproductive services.

Go to the profile of Mary Samplaski
Mary Samplaski almost 4 years ago

The authors are applauded for this work. SV aspiration has fallen out of the armamentarium of many urologists with the growing acceptance of TESE and PESA. My question relates to this. What would the authors suggest are the indications for SVA vs TESE/PESA?

Go to the profile of T. Mike Hsieh
T. Mike Hsieh almost 4 years ago

I do not always have good result with SVA in non-EJD obstruction cases. In bilateral testicular trauma cases, it is sometimes the only option for sperm retrieval. my question for the authors is if the timing of sperm retrieval after injury has an impact on sperm retrieval outcomes.