The 23rd Annual Meeting of the American Society of Andrology (ASA) was convened in Long Beach, California in March 1998. In conjunction with and sponsored by the ASA and an educational grant from Serono Laboratories, Inc, the Andrology Laboratories Committee (ALC) held its most highly attended and successful Workshop to date, entitled: "In Search of the Elusive Sperm." The Workshop, directed by Christopher De Jonge was ably chaired by Pasquale Patrizio with assistance from Erma Drobnis.
The Workshop was formulated with the recognition that:
- Assisted Reproductive Technologies (ART's) are greatly advancing our ability to facilitate the reproductive process for the subfertile couple; and
- some of the methodologies and techniques that are now used in the rapidly advancing ART's can be problematic not only from a technical standpoint but also from medical and ethical.
Thus, the Workshop was specifically designed to provide key background information to facilitate the understanding, current use and the potential applications of some of these more advanced ART's.
Given the vast number of situations and issues that now confront the andrologist it was felt that the course objectives and content should address that diversity, and promote:
- understanding of the pathophysiology of human spermatogenesis and epididymal function;
- understanding of the pathophysiology of erection and ejaculation;
- familiarity with techniques for isolating non-ejaculated spermatozoa;
- familiarity with techniques for artificially stimulating ejaculation;
- understanding of methods for isolating and freezing epididymal and testicular spermatozoa; and
- understanding of practical and ethical dilemmas associated with post-mortem sperm collection.
Wael Salameh (California) performed a 'yeoman's job' by serving as a last minute substitute for an ill speaker. With only several hours to prepare, Dr. Salameh started the day with his very cogent and thought-provoking lecture on "Pathophysiology of human spermatogenesis and epididymal function". Dr. Salameh highlighted those loci in the aforementioned processes that have been identified as being susceptible to perturbation. Indeed, many of the targets that were presented have molecular identities that are just beginning to be characterized.
The day's second speaker was Jacob Rajfer (California) who presented: "From erection to ejaculation: what can go wrong?" Dr. Rajfer presented his talk in three parts; the first topic was erection, the second was emission, and the third was ejaculation. Four major causes for erectile dysfunction were identified with the diagnosis being made after a thorough history and physical examination. For example, the combined use of pharmacologic agents (papaverine, phentolamine, and PGE1) that impact on the vascular system help to diagnose whether that system is involved in the dysfunction. Dr. Rajfer then spoke about emission, which is the depositing of the ejaculate into the posterior urethra. Various pathologies can be identified with emission dysfunction and some of those are: neuromuscular and anatomical. Dr. Rajfer emphasized the importance of transrectal ultrasound for assessing the integrity of the ejaculatory ducts and seminal vesicles. His final topic was ejaculation and two types of dysfunction can be described: retrograde and delayed or anejaculation. Many of us are familiar with retrograde ejaculation and some of the causes behind this abnormal ejaculate deposition, e.g., a-adrenergic blockers used for BPH, diabetes mellitus, and iatrogenic causes. Anejaculation may be caused by the use of serotonin release uptake inhibitors and hypogonadism. Pseudo anejaculation can result from CBAVD or complete bilateral ejaculatory duct obstruction, where very little ejaculate is produced (any fluid would be derived from the prostate).
Christopher De Jonge, USA