Monthly Archives: July 2017

Introduction of Sperm Banking | Minnesota

Cryopreservation (rapid freezing) is the method of preserving sperm for future use. There are many reasons an individual would choose to prepare for possible sterility, including

1. Pending cancer treatments
2. Elective vasectomy
3. Infertility (use frozen donor semen)
4. Initiating hormone therapy
5. Having a high risk job.

For some men, sperm banking is almost a necessity. Men diagnosed with cancer during their early 20’s face a course of chemotherapy likely to provide a cure but also likely to adversely affect sperm production. Their only hope of fathering children is with preservation and storage of sperm obtained prior to chemotherapy. For years, sperm banks have been providing this service.

On occasion, a vasectomy candidate will ask about storing his sperm prior to undergoing vasectomy. The question is whether sperm freezing and storage (cryopreservation) might be considered a reasonable alternative to vasectomy reversal in the unlikely event that the individual wishes to father children in the future.

For another group of men, infertility has necessitated use of donor semen. While these men may be infertile for a variety of reasons, use of donor sperm allows their wives to experience pregnancy and childbirth, obviously not part of the adoption process. Nearly all donor sperm used nowadays is obtained from frozen semen. Fresh semen is almost never used because infected donors may not test positive for hepatitis and AIDS until weeks after donation. Cryopreservation of semen provides the safety net needed to confirm that sperm donors are healthy and have negative tests weeks or months after donating.

Frozen semen can be stored for an indefinite amount of time. It can be used effectively in different types of fertility treatments, including in vitro fertilization (IVF), intrauterine insemination (IUI), or gamete intrafallopian transfer (GIFT).

Effects of Anti-sperm Antibodies in Patients with Vasectomy Reversal | Minnesota

What are Anti–sperm Antibodies?

An antibody is a blood protein produced by your body’s immune system in response to the stimulation of a specific antigen. Common antigens include multiple antigens in bacteria, viruses, cancer cells and foreign substances in the blood. The antibodies combine chemically with antigens and serve to help the body target and fight-off theses “dangerous” or “unwanted” cells or substances. However, it is possible for antibodies to work against the body’s own cells; such is the case in many autoimmune diseases. In cases of vasectomy, especially after long periods of time after the surgery, it is possible for the body to form antisperm antibodies. This is a concern for many patients seeking vasectomy reversal.

This is normally not a problem with sperm cells as they technically not in the body, in the same sense that the inside of our digestive tracts are not considered to be inside the body. Sperm is created in the testes, transported by the vas deferens, mixed with seminal fluid, and exits the body during ejaculation- at no point does sperm ever contact blood, as direct contact is prevented by the testes/blood barrier.

When the blood-testis barrier is compromised under certain circumstances, such as trauma/surgery, infection, cancer and congenital defect, sperm could be exposed to blood and trigger the immune responses, which leads to antibody development. Development of anti-sperm antibodies after vasectomy is thought to be related to the breakdown of the blood-testis barrier and leakage of sperm antigens from the epididymis. For this reason, the body may treat sperm as a foreign pathogen, creating antibodies that correspond to the antigens on the surface of the sperm cell. A vasectomy, especially if a long period of time has passed since the procedure, can result in higher concentrations of anti-sperm antibodies.

Antisperm antibodies are found in between 8% and 21% of men in the general population, 9% and 36% of infertile patients, and 70-100% of men after vasectomy. Studies have provided convincing evidence that a vasectomy does not lead to development of autoantibodies in men other than anti-sperm antibodies, and there is no evidence of any immunologic or other diseases related to development of anti-sperm antibodies following vasectomy.

What is the Relationship of Anti-sperm Antibodies with Vasectomy Reversal Procedures?

Antisperm antibodies can affect fertility in the male if they are in high concentrations. Fertility loss can come at varying degrees; the more antibodies one has, the lower fertility will be. B- immune cells create multiple types of sperm antibodies. Some antibodies will cause sperm to stick together, forming large clumps that hinder mobility of the sperm. Other antibodies act as a “flag” for natural killer cells, and others can even bind with the antigens on the surface of the egg in the womb, causing its destruction.

How Anti-sperm antibodies affect fertility following vasectomy reversal is not clear. While 79% of men that are tested after a vasectomy have elevated antisperm antibodies, the levels at which they are present are not significant enough in most men to cause a significant drop in fertility. Most experts, including those from the American Urological Association, agree that there are rarely significant long-term side effects that arise from vasectomy.

The practice guidelines of the American Society for Reproductive Medicine and the Society for Male Reproduction and Urology stated:

“Overall postoperative conception rate (following vasectomy reversal) is relatively high (50% to 70%) and the presence of antisperm antibodies does not correlate closely with postoperative fecundability. Consequently, the value of preoperative antisperm antibody testing remains controversial and unproven.”

Here is a summary of research evidence:

1) Despite almost all men having detectable antibodies following a vasectomy, two thirds of vasectomy reversals are successful in achieving a pregnancy.
2) The presence and levels of antibodies following vasectomy reversal inconsistently predicts what couples will be successful in achieving a pregnancy.
3) The subjects of most research were infertile men. Research data from fertile men is lacking.
4) Testing for sperm antibodies is not well standardized. There are different types of antibodies and different locations in the sperm. The influences from each antibody are unclear.

RISUG- An Exciting, Potential Vasectomy Alternative | Minnesota

Reversible inhibition of sperm under guidance (RISUG) is a procedure that could someday replace vasectomy as a long-term form of birth control. While RISUG and vasectomies have similar goals, the way they achieve those goals are quite different. Vasectomies involve cutting the vas deferens, and tying/stapling/cauterizing the open ends of the vas deferens. Even with the minimally invasive no-scalpel vasectomy, it is still a surgical procedure. RISUG is different- there is no cutting involved. Instead of severing the vas deferens, a polymer known as styrene maleic anhydride (SMA) is injected into the vas, which quickly hardens. This barrier does not block sperm; rather, it renders all the sperm that passes through it inactive, preventing conception. Reversing it simply requires another injection which dissolves the polymer, allowing the passage of motile sperm.

RISUG provides a solution for a couple of problems that still affect vasectomies. First, it prevents backpressure from sperm in the epididymis and granulomas, which, while rare, are still a potential inconvenience for some who have a regular vasectomy. While RISUG procedure is not permanent (~10 years), it is very affordable and can be replaced indefinitely. It’s impermanence is a feature for some, as it is very easy to reverse the procedure. In the past few years, vasectomy reversals have become very effective, but they’re still known to fail and are costly compared to the initial vasectomy. The recovery time is short, and couples may resume intercourse within a week.

Unfortunately, its development both here and abroad has been rocky. As of last year, advanced clinical trials on humans had very few volunteers- just 64 out of a targeted 500. In the US, the intellectual property rights are owned by the Parsemus Foundation, a non-profit, and is called “Vasalgel™”. Animal trials so far have been successful, but it still may be some time until human trials begin. Hopefully, this technology will one day revolutionize male birth control, but for now no-scalpel vasectomies are the best option for those seeking long-term male birth control.

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