agonist) achieved significantly higher LBRs than all other protocols (17.1%, P < 0.001). This per... more agonist) achieved significantly higher LBRs than all other protocols (17.1%, P < 0.001). This persisted when stratifying by age (<35; 30%, 35-37; 29%, 38þ; 12.6%). A mixed effects logistic regression model demonstrated that only age returned as a significant negative predictor of LBR (aOR 0.9, 95% CI 0.86-0.94, P < 0.001). There was no effect of TMSC on LBR (aOR 1.0, 95% CI 0.99-1.02, P ¼ 0.7). Gonadotropin stimulation was associated with over double increased odds of achieving a live birth, which came close to significance (aOR 2.29, 95% CI 0.98-5.4, P ¼ 0.06). Limitations, reasons for caution: The choice of management regimen could have been influenced by uncontrolled factors, introducing bias in this retrospective study. Other semen parameters were not included in the multivariate analyses which could, in turn, have affected live birth outcome, which should be considered. Wider implications of the findings: These findings demonstrate that increasing TMSC may be associated with small rises in LBR up to 25x10 6 in D-IUI cycles. While gonadotrophin stimulation appeared most effective, only age was shown to be an independent predictor of LBR. Collectively, these parameters may assist clinicians in optimising LBR in D-IUI cycles.
BACKGROUND: Demand for assisted conception amongst HIV-infected couples is rising in parallel wit... more BACKGROUND: Demand for assisted conception amongst HIV-infected couples is rising in parallel with increased efficacy of antiretroviral medication which has improved life expectancy and reduced vertical transmission risk. There are no published data on welfare of the child assessment in HIV positive couples undergoing assisted conception. METHODS: We assessed welfare of the child in 131 (i.e. total number seen, not treated) couples, where one or both partners were infected with HIV and referred to the infertility clinic at Chelsea and Westminster Hospital since 1999. In total, 59 couples received sperm washing treatment (male partner infected) resulting in 17 healthy babies, and 14 couples were treated in the female positive programme (5 concordant and 9 discordant for HIV) resulting in three healthy babies. RESULTS: Issues surrounding welfare of the child were commonly encountered in this series and were significant enough to withhold treatment in five cases. Many were relationship issues surrounding acquisition of infection, fear of infection in the negative partner or child (n 5 1), poor prognosis (multiple drug resistance) (n 5 3) or disability related to infection (n 5 1). CONCLUSIONS: Welfare of the child in HIV infected couples must be carefully considered in specialist centres with experienced counsellors. Issues surrounding treatment are complex and require close liaison with HIV specialists and involvement of the couple.
Objective: To collect data on the demand and provision of fertility care in HIV-infected couples ... more Objective: To collect data on the demand and provision of fertility care in HIV-infected couples in the United Kingdom and data on the etiology of subfertility in this population. Design: A postal questionnaire survey and audit of causes of infertility in HIV-infected women. Setting: Seventy-four Human Embryology and Fertilisation Authority-registered assisted conception units (ACUs) and 294 genitourinary medicine (GUM) clinics in the United Kingdom were sent questionnaires. Patient(s): Sixty-five HIV-infected women attending the Research Clinic at the Chelsea and Westminster ACU. Intervention(s): None. Main Outcome Measure(s): Number of ACUs treating HIV-infected patients and number of GUM clinics receiving requests for referral, as well as the etiology of subfertility in HIV-infected women attending our clinic. Result(s): Response rates from ACUs and GUM clinics were 93% and 63%, respectively. Fourteen ACUs (20%) were treating HIV-infected men; of these, seven (10%) performed sperm washing, but only two (3%) tested sperm for HIV after processing, before use. Nine units (13%) treated HIV-infected women, but only three ACUs (4%) had separate laboratories for handling potentially infected gametes or embryos. Of the 15,211 patients registered in 81 GUM clinics, 4% of the men and 16% of the women had requested advice on conceiving. An audit of the Chelsea and Westminster HIV fertility clinic demonstrated a 40% prevalence of tubal factor infertility in HIV-infected women. Conclusion(s): Demand is high, and set to increase, but current suboptimal practice in some centers is placing unaffected partners and the unborn child at risk of seroconversion.
Objective: To present the first reported case of synchronous sperm retrieval followed by sperm wa... more Objective: To present the first reported case of synchronous sperm retrieval followed by sperm washing before an intracytoplasmic sperm injection (ICSI) cycle in an HIV-positive azoospermic man. Design: Case report. Setting: Assisted reproduction center. Patient(s): A 40-year-old HIV-positive man with obstructive azoospermia due to vasal aplasia. Intervention(s): Synchronous sperm retrieval, sperm washing, nucleic acid-based sequence amplification testing, and intracytoplasmic sperm injection. Main Outcome Measure(s): Successful sperm retrieval sufficient for sperm washing and fertilization. Result(s): Sufficient quantity of spermatozoa for washing was obtained at epididymal aspiration. After the wash, HIV ribonucleic acid (RNA) was undetectable with nucleic acid-based sequence amplification testing, enabling injection of oocytes collected after routine gonadotropin superovulation. Of seven oocytes collected from the 39-year-old woman partner, six were injected and five fertilized (83%). Three embryos were transferred on day 2. The pregnancy test was negative on this occasion. Conclusion(s): This case demonstrates that sperm washing can be applied in cases of sperm retrieval where sperm volume and density is low, allowing the treatment of azoospermic HIV-positive men.
Introduction: Premature ejaculation (PE) is defined as ejaculation within 1 minute (lifelong PE) ... more Introduction: Premature ejaculation (PE) is defined as ejaculation within 1 minute (lifelong PE) or 3 minutes (acquired PE), inability to delay ejaculation, and negative personal consequences. Management includes behavioral and pharmacologic approaches. Aim: To systematically review effectiveness, safety, and robustness of evidence for complementary and alternative medicine in managing PE. Methods: Nine databases including Medline were searched through September 2015. Randomized controlled trials evaluating complementary and alternative medicine for PE were included. Main Outcome Measures: Studies were included if they reported on intravaginal ejaculatory latency time (IELT) and/or another validated PE measurement. Adverse effects were summarized. Results: Ten randomized controlled trials were included. Two assessed acupuncture, five assessed Chinese herbal medicine, one assessed Ayurvedic herbal medicine, and two assessed topical "severance secret" cream. Risk of bias was unclear in all studies because of unclear allocation concealment or blinding, and only five studies reported stopwatch-measured IELT. Acupuncture slightly increased IELT over placebo in one study (mean difference [MD] ¼ 0.55 minute, P ¼ .001). In another study, Ayurvedic herbal medicine slightly increased IELT over placebo (MD ¼ 0.80 minute, P ¼ .001). Topical severance secret cream increased IELT over placebo in two studies (MD ¼ 8.60 minutes, P < .001), although inclusion criteria were broad (IELT < 3 minutes). Three studies comparing Chinese herbal medicine with selective serotonin reuptake inhibitors (SSRIs) favored SSRIs (MD ¼ 1.01 minutes, P ¼ .02). However, combination treatment with Chinese medicine plus SSRIs improved IELT over SSRIs alone (two studies; MD ¼ 1.92 minutes, P < .00001) and over Chinese medicine alone (two studies; MD ¼ 2.52 minutes, P < .00001). Adverse effects were not consistently assessed but where reported were generally mild. Conclusion: There is preliminary evidence for the effectiveness of acupuncture, Chinese herbal medicine, Ayurvedic herbal medicine, and topical severance secret cream in improving IELT and other outcomes. However, results are based on clinically heterogeneous studies of unclear quality. There are sparse data on adverse effects or potential for drug interactions. Further well-conducted randomized controlled trials would be valuable. Cooper K, Martyn-St James M, Kaltenhaler E, et al. Complementary and Alternative Medicine for Management of Premature Ejaculation: A Systematic Review. Sex Med 2017;5:e1ee18.
Context: Phosphodiesterase-5 inhibitors (PDE5is) are prescribed off-label for the treatment of pr... more Context: Phosphodiesterase-5 inhibitors (PDE5is) are prescribed off-label for the treatment of premature ejaculation (PE). Objective: To systematically review the evidence from randomised controlled trials (RCTs) for PDE5is in the management of PE. Evidence acquisition: MEDLINE and other databases were searched to September 2015. Quality of RCTs was assessed. Intra-vaginal ejaculatory latency time (IELT) data were pooled in a metaanalysis. Heterogeneity was assessed. Evidence synthesis: Fifteen RCTs were included. The majority were of unclear methodological quality. Pooled IELT evidence suggests: PDE5is are significantly more effective than placebo (231 participants, p<0.00001); there is no difference between PDE5is and selective serotonin reuptake inhibitors (SSRIs) (405 participants, p=0.50); and that PDE5is combined with an SSRI are significantly more effective than SSRIs alone (521 participants, p=0.001). However, high levels of statistical heterogeneity are evident (I 2 ≥40%). Single RCT evidence suggests that sildenafil is significantly more effective than the squeeze technique; but both lidocaine gel and tramadol are significantly more effective than sildenafil. Sildenafil combined with behavioural therapy is significantly more effective than behavioural therapy alone. Sexual satisfaction and ejaculatory control appear better with PDE5is compared with placebo and with PDE5is combined with an SSRI compared with an SSRI alone. Adverse events are reported with both PDE5is and other agents. Conclusions: PDE5is are significantly more effective than placebo and PDE5is combined with an SSRI are significantly more effective than SSRIs alone at increasing IELT and improvement in other effectiveness outcomes. However, heterogeneity is evident across RCTs. The methodological quality of the majority of RCTs is unclear. Patient summary: We reviewed PDE5is for treating premature ejaculation. We found evidence to suggest that PDE5is are effective compared with placebo and that PDE5is combined with an SSRI are better than an SSRI alone. Adverse events are reported with PDE5is and other agents. However, the quality of the evidence is uncertain.
Background: Tramadol is a centrally acting analgesic prescribed off-label for the treatment of pr... more Background: Tramadol is a centrally acting analgesic prescribed off-label for the treatment of premature ejaculation (PE). However, tramadol may cause addiction and difficulty in breathing and the beneficial effect of tramadol in PE is yet not supported by a high level of evidence. The purpose of this study was to systematically review the evidence from randomised controlled trials (RCT) for tramadol in the management of PE. Methods: We searched bibliographic databases including MEDLINE to August 2014 for RCTs. The primary outcome was intra-vaginal ejaculatory latency time (IELT). Methodological quality of RCTs was assessed. Between-group differences in IELT and other outcomes were pooled across RCTs in a meta-analysis. Statistical and clinical between-trial heterogeneity was assessed. Results: A total of eight RCTs that evaluated tramadol against a comparator were included. The majority of RCTs were of unclear methodological quality due to limited reporting. Pooled evidence (four RCTs, 721 participants), suggests that tramadol is significantly more effective than placebo at increasing IELT over eight to 12 weeks (p = 0.0007). However, a high level of statistical heterogeneity is evident (I-squared = 74%). Single RCT evidence indicates that tramadol is significantly more effective than paroxetine taken on-demand, sildenafil, lidocaine gel, or behavioural therapy on IELT in men with PE. Tramadol is associated with significantly more adverse events including: erectile dysfunction, constipation, nausea, headache, somnolence, dry mouth, dizziness, pruritus, and vomiting, than placebo or behavioural therapy over eight to 12 weeks of treatment. However, addiction problems or breathing difficulties reported by patients for PE is not assessed in the current evidence base. Conclusions: Tramadol appears effective in the treatment of PE. However, these findings should be interpreted with caution given the observed levels of between-trial heterogeneity and the reporting quality of the available evidence. The variability across placebo-controlled trials in terms of the tramadol dose evaluated and the treatment duration does not permit any assessment of a safe and effective minimum daily dose. The long-term effects and side effects, including addiction potential, for men with PE have not been evaluated in the current evidence base. Trial registration: The review is registered on PROSPERO 2013:CRD42013005289.
Background: Premature ejaculation (PE) is commonly defined as ejaculation with minimal sexual sti... more Background: Premature ejaculation (PE) is commonly defined as ejaculation with minimal sexual stimulation before, on or shortly after penetration and before the person wishes it. PE can be either lifelong and present since first sexual experiences (primary), or acquired (secondary), beginning later (Godpodinoff ML. Premature ejaculation: clinical subgroups and etiology. J Sex Marital Ther 1989;15:130–4). Treatments include behavioural and pharmacological interventions. Objective: To systematically review evidence for clinical effectiveness of behavioural, topical and systemic treatments for PE. Data sources: The following databases were searched from inception to 6 August 2013 for published and unpublished research evidence: MEDLINE; EMBASE; Cumulative Index to Nursing and Allied Health Literature; The Cochrane Library including the Cochrane Systematic Reviews Database, Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effects and the Health Technology Assessment database; ISI Web of Science, including Science Citation Index, and the Conference Proceedings Citation Index-Science. The US Food and Drug Administration website and the European Medicines Agency (EMA) website were also searched. Methods: Randomised controlled trials (RCTs) in adult men with PE were eligible (or non-RCTs in the absence of RCTs). RCT data were extrapolated from review articles when available. The primary outcome was intravaginal ejaculatory latency time (IELT). Data were meta-analysed when possible. Other outcomes included sexual satisfaction, control over ejaculation, relationship satisfaction, self-esteem, quality of life, treatment acceptability and adverse events (AEs). Results: A total of 103 studies (102 RCTs, 65 from reviews) were included. RCTs were available for all interventions except yoga. The following interventions demonstrated significant improvements (p < 0.05) in arithmetic mean difference in IELT compared with placebo: topical anaesthetics – eutectic mixture of local anaesthetics (EMLA®, AstraZeneca), topical eutectic mixture for PE (Plethora Solutions Ltd) spray; selective serotonin reuptake inhibitors (SSRIs) – citalopram (Cipramil®, Lundbeck), escitalopram (Cipralex®, Lundbeck), fluoxetine, paroxetine, sertraline, dapoxetine (Priligy®, Menarini), 30 mg or 60 mg; serotonin–noradrenaline reuptake inhibitors – duloxetine (Cymbalta®, Eli Lilly & Co Ltd); tricyclic antidepressants – inhaled clomipramine 4 mg; phosphodiesterase-5 (PDE5) inhibitors – vardenafil (Levitra®, Bayer), tadalafil (Cialis®, Eli Lilly & Co Ltd); opioid analgesics – tramadol (Zydol SR®, Grunenthal). Improvements in sexual satisfaction and other outcomes compared with placebo were evident for SSRIs, PDE5 inhibitors and tramadol. Outcomes for interventions not compared with placebo were as follows: behavioural therapies – improvements over wait list control in IELT and other outcomes, behavioural therapy plus pharmacotherapy better than either therapy alone; alpha blockers – terazosin (Hytrin®, AMCO) not significantly different to antidepressants in ejaculation control; acupuncture – improvements over sham acupuncture in IELT, conflicting results for comparisons with SSRIs; Chinese medicine – improvements over treatment as usual; delay device – improvements in IELT when added to stop–start technique; yoga – improved IELT over baseline, fluoxetine better than yoga. Treatment-related AEs were evident with most pharmacological interventions. Limitations: Although data extraction from reviews was optimised when more than one review reported data for the same RCT, the reliability of the data extraction within these reviews cannot be guaranteed by this assessment report. Conclusions: Several interventions significantly improved IELT. Many interventions also improved sexual satisfaction and other outcomes. However, assessment of longer-term safety and effectiveness is required to evaluate whether or not initial treatment effects are maintained long term, whether or not dose escalation is required, how soon treatment effects end following treatment cessation and whether or not treatments can be stopped and resumed at a later time. In addition, assessment of the AEs associated with long-term treatment and whether or not different doses have differing AE profiles is required.
Introduction: Premature ejaculation (PE) is defined as ejaculation within 1 minute (lifelong PE) ... more Introduction: Premature ejaculation (PE) is defined as ejaculation within 1 minute (lifelong PE) or 3 minutes (acquired PE), inability to delay ejaculation, and negative personal consequences. Management includes behavioral and pharmacologic approaches. Aim: To systematically review effectiveness, safety, and robustness of evidence for complementary and alternative medicine in managing PE. Methods: Nine databases including Medline were searched through September 2015. Randomized controlled trials evaluating complementary and alternative medicine for PE were included. Main Outcome Measures: Studies were included if they reported on intravaginal ejaculatory latency time (IELT) and/or another validated PE measurement. Adverse effects were summarized. Results: Ten randomized controlled trials were included. Two assessed acupuncture, five assessed Chinese herbal medicine, one assessed Ayurvedic herbal medicine, and two assessed topical "severance secret" cream. Risk of bias was unclear in all studies because of unclear allocation concealment or blinding, and only five studies reported stopwatch-measured IELT. Acupuncture slightly increased IELT over placebo in one study (mean difference [MD] ¼ 0.55 minute, P ¼ .001). In another study, Ayurvedic herbal medicine slightly increased IELT over placebo (MD ¼ 0.80 minute, P ¼ .001). Topical severance secret cream increased IELT over placebo in two studies (MD ¼ 8.60 minutes, P < .001), although inclusion criteria were broad (IELT < 3 minutes). Three studies comparing Chinese herbal medicine with selective serotonin reuptake inhibitors (SSRIs) favored SSRIs (MD ¼ 1.01 minutes, P ¼ .02). However, combination treatment with Chinese medicine plus SSRIs improved IELT over SSRIs alone (two studies; MD ¼ 1.92 minutes, P < .00001) and over Chinese medicine alone (two studies; MD ¼ 2.52 minutes, P < .00001). Adverse effects were not consistently assessed but where reported were generally mild. Conclusion: There is preliminary evidence for the effectiveness of acupuncture, Chinese herbal medicine, Ayurvedic herbal medicine, and topical severance secret cream in improving IELT and other outcomes. However, results are based on clinically heterogeneous studies of unclear quality. There are sparse data on adverse effects or potential for drug interactions. Further well-conducted randomized controlled trials would be valuable. Cooper K, Martyn-St James M, Kaltenhaler E, et al. Complementary and Alternative Medicine for Management of Premature Ejaculation: A Systematic Review. Sex Med 2017;5:e1ee18.
Journal of Reproductive and Infant Psychology, 2020
Premna esculenta The present study was done to evaluate the hepatoprotective and the in vivo 4 di... more Premna esculenta The present study was done to evaluate the hepatoprotective and the in vivo 4 diluted Dunnett's t P 4 P P. esculenta showed a potential hepatoprotective activity and the protective action might have manifested by in liver disorders.
Introduction Klinefelter's syndrome is the most common chromosomal abnormality seen in men, a... more Introduction Klinefelter's syndrome is the most common chromosomal abnormality seen in men, affecting 1 in 650 men. It is a group of chromosomal disorders with at least one extra X chromosome (47, XXY) occurring due to non-disjunction at the time of gametogenesis. Most adult men are diagnosed at the time of fertility investigations. However, the syndrome has an array of clinical presentations which patients require input from numerous medical specialities during their lifetime. The setting up of a national-access Klinefelter Syndrome multidisciplinary clinic (KSMDT) approach comprising Urology, Endocrinology, Genetics, Reproductive medicine, Radiology, Psychosexual medicine, a specialist pharmacist as well as a patient representative has led to improvements in fertility and long- term management and waiting times. Here we describe the patient-reported outcomes and clinician perspectives of the clinic as it approached its 1st year. Method Between 2019 and 2020, 72 patients were s...
This chapter is mainly concerned with sexually transmitted infections and covers a range of issue... more This chapter is mainly concerned with sexually transmitted infections and covers a range of issues, including Chlamydia, gonorrhoea, hepatitis B and C, herpes, syphilis, and other vaginal infections such as Candida, Trichomonas vaginalis, and bacterial vaginitis. Each of these is taken separately with reference to a screening programme, if appropriate, clinical symptoms and appearance, diagnosis, the latest guidance on treatment, and considerations for pregnancy. Fetal and neonatal infections, congenital transmission, treatment, and surveillance options for the neonate, along with specific advice for the mother are also given.
Objective: To study the differences in sexual dysfunction and time to pregnancy (TTP) between inf... more Objective: To study the differences in sexual dysfunction and time to pregnancy (TTP) between infertile couples pursuing timed intercourse (TI – around the time of ovulation) and regular intercourse (RI – at least twice a week). Methods: In this prospective cohort study, we recruited all infertile couples presenting to the regional infertility clinics from January 2016 to December 2018, pursuing TI ( n = 283) or RI ( n = 88), and having no pre-existing sexual or psychiatric illness, and no medical contraindications to frequent intercourse. Sexual dysfunction was assessed using the Arizona Sexual Experience Scale and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The couples for whom natural conception was possible were followed up to determine TTP using Kaplan–Meier analysis. Results: TI significantly increased the risk of sexual dysfunction than RI for both males and females, even after adjusting for age, medical disorders, obesity, smoking, cause of infe...
This chapter covers problems that can occur with sexual health in women. It starts with the defin... more This chapter covers problems that can occur with sexual health in women. It starts with the definition, assessment, diagnosis, investigations, and treatment of different sorts of vaginal discharge. It provides information about sexual health in context, including its links with other forms of disease and psychological well-being. Protocols for partner notification in the cases of diagnosis with a sexually transmitted disease are explained. The signs, symptoms, and treatment for gonorrhea, chlamydia, and Mycoplasma genitalium are all covered. It also covers the definition, causes, diagnosis, and treatment of pelvic inflammatory disease. Hepatitis B and C are described, along with anogenital warts, genital herpes, and genital lumps and ulcers. Finally HIV and new developments such as PrEP and PEP are covered.
agonist) achieved significantly higher LBRs than all other protocols (17.1%, P < 0.001). This per... more agonist) achieved significantly higher LBRs than all other protocols (17.1%, P < 0.001). This persisted when stratifying by age (<35; 30%, 35-37; 29%, 38þ; 12.6%). A mixed effects logistic regression model demonstrated that only age returned as a significant negative predictor of LBR (aOR 0.9, 95% CI 0.86-0.94, P < 0.001). There was no effect of TMSC on LBR (aOR 1.0, 95% CI 0.99-1.02, P ¼ 0.7). Gonadotropin stimulation was associated with over double increased odds of achieving a live birth, which came close to significance (aOR 2.29, 95% CI 0.98-5.4, P ¼ 0.06). Limitations, reasons for caution: The choice of management regimen could have been influenced by uncontrolled factors, introducing bias in this retrospective study. Other semen parameters were not included in the multivariate analyses which could, in turn, have affected live birth outcome, which should be considered. Wider implications of the findings: These findings demonstrate that increasing TMSC may be associated with small rises in LBR up to 25x10 6 in D-IUI cycles. While gonadotrophin stimulation appeared most effective, only age was shown to be an independent predictor of LBR. Collectively, these parameters may assist clinicians in optimising LBR in D-IUI cycles.
BACKGROUND: Demand for assisted conception amongst HIV-infected couples is rising in parallel wit... more BACKGROUND: Demand for assisted conception amongst HIV-infected couples is rising in parallel with increased efficacy of antiretroviral medication which has improved life expectancy and reduced vertical transmission risk. There are no published data on welfare of the child assessment in HIV positive couples undergoing assisted conception. METHODS: We assessed welfare of the child in 131 (i.e. total number seen, not treated) couples, where one or both partners were infected with HIV and referred to the infertility clinic at Chelsea and Westminster Hospital since 1999. In total, 59 couples received sperm washing treatment (male partner infected) resulting in 17 healthy babies, and 14 couples were treated in the female positive programme (5 concordant and 9 discordant for HIV) resulting in three healthy babies. RESULTS: Issues surrounding welfare of the child were commonly encountered in this series and were significant enough to withhold treatment in five cases. Many were relationship issues surrounding acquisition of infection, fear of infection in the negative partner or child (n 5 1), poor prognosis (multiple drug resistance) (n 5 3) or disability related to infection (n 5 1). CONCLUSIONS: Welfare of the child in HIV infected couples must be carefully considered in specialist centres with experienced counsellors. Issues surrounding treatment are complex and require close liaison with HIV specialists and involvement of the couple.
Objective: To collect data on the demand and provision of fertility care in HIV-infected couples ... more Objective: To collect data on the demand and provision of fertility care in HIV-infected couples in the United Kingdom and data on the etiology of subfertility in this population. Design: A postal questionnaire survey and audit of causes of infertility in HIV-infected women. Setting: Seventy-four Human Embryology and Fertilisation Authority-registered assisted conception units (ACUs) and 294 genitourinary medicine (GUM) clinics in the United Kingdom were sent questionnaires. Patient(s): Sixty-five HIV-infected women attending the Research Clinic at the Chelsea and Westminster ACU. Intervention(s): None. Main Outcome Measure(s): Number of ACUs treating HIV-infected patients and number of GUM clinics receiving requests for referral, as well as the etiology of subfertility in HIV-infected women attending our clinic. Result(s): Response rates from ACUs and GUM clinics were 93% and 63%, respectively. Fourteen ACUs (20%) were treating HIV-infected men; of these, seven (10%) performed sperm washing, but only two (3%) tested sperm for HIV after processing, before use. Nine units (13%) treated HIV-infected women, but only three ACUs (4%) had separate laboratories for handling potentially infected gametes or embryos. Of the 15,211 patients registered in 81 GUM clinics, 4% of the men and 16% of the women had requested advice on conceiving. An audit of the Chelsea and Westminster HIV fertility clinic demonstrated a 40% prevalence of tubal factor infertility in HIV-infected women. Conclusion(s): Demand is high, and set to increase, but current suboptimal practice in some centers is placing unaffected partners and the unborn child at risk of seroconversion.
Objective: To present the first reported case of synchronous sperm retrieval followed by sperm wa... more Objective: To present the first reported case of synchronous sperm retrieval followed by sperm washing before an intracytoplasmic sperm injection (ICSI) cycle in an HIV-positive azoospermic man. Design: Case report. Setting: Assisted reproduction center. Patient(s): A 40-year-old HIV-positive man with obstructive azoospermia due to vasal aplasia. Intervention(s): Synchronous sperm retrieval, sperm washing, nucleic acid-based sequence amplification testing, and intracytoplasmic sperm injection. Main Outcome Measure(s): Successful sperm retrieval sufficient for sperm washing and fertilization. Result(s): Sufficient quantity of spermatozoa for washing was obtained at epididymal aspiration. After the wash, HIV ribonucleic acid (RNA) was undetectable with nucleic acid-based sequence amplification testing, enabling injection of oocytes collected after routine gonadotropin superovulation. Of seven oocytes collected from the 39-year-old woman partner, six were injected and five fertilized (83%). Three embryos were transferred on day 2. The pregnancy test was negative on this occasion. Conclusion(s): This case demonstrates that sperm washing can be applied in cases of sperm retrieval where sperm volume and density is low, allowing the treatment of azoospermic HIV-positive men.
Introduction: Premature ejaculation (PE) is defined as ejaculation within 1 minute (lifelong PE) ... more Introduction: Premature ejaculation (PE) is defined as ejaculation within 1 minute (lifelong PE) or 3 minutes (acquired PE), inability to delay ejaculation, and negative personal consequences. Management includes behavioral and pharmacologic approaches. Aim: To systematically review effectiveness, safety, and robustness of evidence for complementary and alternative medicine in managing PE. Methods: Nine databases including Medline were searched through September 2015. Randomized controlled trials evaluating complementary and alternative medicine for PE were included. Main Outcome Measures: Studies were included if they reported on intravaginal ejaculatory latency time (IELT) and/or another validated PE measurement. Adverse effects were summarized. Results: Ten randomized controlled trials were included. Two assessed acupuncture, five assessed Chinese herbal medicine, one assessed Ayurvedic herbal medicine, and two assessed topical "severance secret" cream. Risk of bias was unclear in all studies because of unclear allocation concealment or blinding, and only five studies reported stopwatch-measured IELT. Acupuncture slightly increased IELT over placebo in one study (mean difference [MD] ¼ 0.55 minute, P ¼ .001). In another study, Ayurvedic herbal medicine slightly increased IELT over placebo (MD ¼ 0.80 minute, P ¼ .001). Topical severance secret cream increased IELT over placebo in two studies (MD ¼ 8.60 minutes, P < .001), although inclusion criteria were broad (IELT < 3 minutes). Three studies comparing Chinese herbal medicine with selective serotonin reuptake inhibitors (SSRIs) favored SSRIs (MD ¼ 1.01 minutes, P ¼ .02). However, combination treatment with Chinese medicine plus SSRIs improved IELT over SSRIs alone (two studies; MD ¼ 1.92 minutes, P < .00001) and over Chinese medicine alone (two studies; MD ¼ 2.52 minutes, P < .00001). Adverse effects were not consistently assessed but where reported were generally mild. Conclusion: There is preliminary evidence for the effectiveness of acupuncture, Chinese herbal medicine, Ayurvedic herbal medicine, and topical severance secret cream in improving IELT and other outcomes. However, results are based on clinically heterogeneous studies of unclear quality. There are sparse data on adverse effects or potential for drug interactions. Further well-conducted randomized controlled trials would be valuable. Cooper K, Martyn-St James M, Kaltenhaler E, et al. Complementary and Alternative Medicine for Management of Premature Ejaculation: A Systematic Review. Sex Med 2017;5:e1ee18.
Context: Phosphodiesterase-5 inhibitors (PDE5is) are prescribed off-label for the treatment of pr... more Context: Phosphodiesterase-5 inhibitors (PDE5is) are prescribed off-label for the treatment of premature ejaculation (PE). Objective: To systematically review the evidence from randomised controlled trials (RCTs) for PDE5is in the management of PE. Evidence acquisition: MEDLINE and other databases were searched to September 2015. Quality of RCTs was assessed. Intra-vaginal ejaculatory latency time (IELT) data were pooled in a metaanalysis. Heterogeneity was assessed. Evidence synthesis: Fifteen RCTs were included. The majority were of unclear methodological quality. Pooled IELT evidence suggests: PDE5is are significantly more effective than placebo (231 participants, p<0.00001); there is no difference between PDE5is and selective serotonin reuptake inhibitors (SSRIs) (405 participants, p=0.50); and that PDE5is combined with an SSRI are significantly more effective than SSRIs alone (521 participants, p=0.001). However, high levels of statistical heterogeneity are evident (I 2 ≥40%). Single RCT evidence suggests that sildenafil is significantly more effective than the squeeze technique; but both lidocaine gel and tramadol are significantly more effective than sildenafil. Sildenafil combined with behavioural therapy is significantly more effective than behavioural therapy alone. Sexual satisfaction and ejaculatory control appear better with PDE5is compared with placebo and with PDE5is combined with an SSRI compared with an SSRI alone. Adverse events are reported with both PDE5is and other agents. Conclusions: PDE5is are significantly more effective than placebo and PDE5is combined with an SSRI are significantly more effective than SSRIs alone at increasing IELT and improvement in other effectiveness outcomes. However, heterogeneity is evident across RCTs. The methodological quality of the majority of RCTs is unclear. Patient summary: We reviewed PDE5is for treating premature ejaculation. We found evidence to suggest that PDE5is are effective compared with placebo and that PDE5is combined with an SSRI are better than an SSRI alone. Adverse events are reported with PDE5is and other agents. However, the quality of the evidence is uncertain.
Background: Tramadol is a centrally acting analgesic prescribed off-label for the treatment of pr... more Background: Tramadol is a centrally acting analgesic prescribed off-label for the treatment of premature ejaculation (PE). However, tramadol may cause addiction and difficulty in breathing and the beneficial effect of tramadol in PE is yet not supported by a high level of evidence. The purpose of this study was to systematically review the evidence from randomised controlled trials (RCT) for tramadol in the management of PE. Methods: We searched bibliographic databases including MEDLINE to August 2014 for RCTs. The primary outcome was intra-vaginal ejaculatory latency time (IELT). Methodological quality of RCTs was assessed. Between-group differences in IELT and other outcomes were pooled across RCTs in a meta-analysis. Statistical and clinical between-trial heterogeneity was assessed. Results: A total of eight RCTs that evaluated tramadol against a comparator were included. The majority of RCTs were of unclear methodological quality due to limited reporting. Pooled evidence (four RCTs, 721 participants), suggests that tramadol is significantly more effective than placebo at increasing IELT over eight to 12 weeks (p = 0.0007). However, a high level of statistical heterogeneity is evident (I-squared = 74%). Single RCT evidence indicates that tramadol is significantly more effective than paroxetine taken on-demand, sildenafil, lidocaine gel, or behavioural therapy on IELT in men with PE. Tramadol is associated with significantly more adverse events including: erectile dysfunction, constipation, nausea, headache, somnolence, dry mouth, dizziness, pruritus, and vomiting, than placebo or behavioural therapy over eight to 12 weeks of treatment. However, addiction problems or breathing difficulties reported by patients for PE is not assessed in the current evidence base. Conclusions: Tramadol appears effective in the treatment of PE. However, these findings should be interpreted with caution given the observed levels of between-trial heterogeneity and the reporting quality of the available evidence. The variability across placebo-controlled trials in terms of the tramadol dose evaluated and the treatment duration does not permit any assessment of a safe and effective minimum daily dose. The long-term effects and side effects, including addiction potential, for men with PE have not been evaluated in the current evidence base. Trial registration: The review is registered on PROSPERO 2013:CRD42013005289.
Background: Premature ejaculation (PE) is commonly defined as ejaculation with minimal sexual sti... more Background: Premature ejaculation (PE) is commonly defined as ejaculation with minimal sexual stimulation before, on or shortly after penetration and before the person wishes it. PE can be either lifelong and present since first sexual experiences (primary), or acquired (secondary), beginning later (Godpodinoff ML. Premature ejaculation: clinical subgroups and etiology. J Sex Marital Ther 1989;15:130–4). Treatments include behavioural and pharmacological interventions. Objective: To systematically review evidence for clinical effectiveness of behavioural, topical and systemic treatments for PE. Data sources: The following databases were searched from inception to 6 August 2013 for published and unpublished research evidence: MEDLINE; EMBASE; Cumulative Index to Nursing and Allied Health Literature; The Cochrane Library including the Cochrane Systematic Reviews Database, Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effects and the Health Technology Assessment database; ISI Web of Science, including Science Citation Index, and the Conference Proceedings Citation Index-Science. The US Food and Drug Administration website and the European Medicines Agency (EMA) website were also searched. Methods: Randomised controlled trials (RCTs) in adult men with PE were eligible (or non-RCTs in the absence of RCTs). RCT data were extrapolated from review articles when available. The primary outcome was intravaginal ejaculatory latency time (IELT). Data were meta-analysed when possible. Other outcomes included sexual satisfaction, control over ejaculation, relationship satisfaction, self-esteem, quality of life, treatment acceptability and adverse events (AEs). Results: A total of 103 studies (102 RCTs, 65 from reviews) were included. RCTs were available for all interventions except yoga. The following interventions demonstrated significant improvements (p < 0.05) in arithmetic mean difference in IELT compared with placebo: topical anaesthetics – eutectic mixture of local anaesthetics (EMLA®, AstraZeneca), topical eutectic mixture for PE (Plethora Solutions Ltd) spray; selective serotonin reuptake inhibitors (SSRIs) – citalopram (Cipramil®, Lundbeck), escitalopram (Cipralex®, Lundbeck), fluoxetine, paroxetine, sertraline, dapoxetine (Priligy®, Menarini), 30 mg or 60 mg; serotonin–noradrenaline reuptake inhibitors – duloxetine (Cymbalta®, Eli Lilly & Co Ltd); tricyclic antidepressants – inhaled clomipramine 4 mg; phosphodiesterase-5 (PDE5) inhibitors – vardenafil (Levitra®, Bayer), tadalafil (Cialis®, Eli Lilly & Co Ltd); opioid analgesics – tramadol (Zydol SR®, Grunenthal). Improvements in sexual satisfaction and other outcomes compared with placebo were evident for SSRIs, PDE5 inhibitors and tramadol. Outcomes for interventions not compared with placebo were as follows: behavioural therapies – improvements over wait list control in IELT and other outcomes, behavioural therapy plus pharmacotherapy better than either therapy alone; alpha blockers – terazosin (Hytrin®, AMCO) not significantly different to antidepressants in ejaculation control; acupuncture – improvements over sham acupuncture in IELT, conflicting results for comparisons with SSRIs; Chinese medicine – improvements over treatment as usual; delay device – improvements in IELT when added to stop–start technique; yoga – improved IELT over baseline, fluoxetine better than yoga. Treatment-related AEs were evident with most pharmacological interventions. Limitations: Although data extraction from reviews was optimised when more than one review reported data for the same RCT, the reliability of the data extraction within these reviews cannot be guaranteed by this assessment report. Conclusions: Several interventions significantly improved IELT. Many interventions also improved sexual satisfaction and other outcomes. However, assessment of longer-term safety and effectiveness is required to evaluate whether or not initial treatment effects are maintained long term, whether or not dose escalation is required, how soon treatment effects end following treatment cessation and whether or not treatments can be stopped and resumed at a later time. In addition, assessment of the AEs associated with long-term treatment and whether or not different doses have differing AE profiles is required.
Introduction: Premature ejaculation (PE) is defined as ejaculation within 1 minute (lifelong PE) ... more Introduction: Premature ejaculation (PE) is defined as ejaculation within 1 minute (lifelong PE) or 3 minutes (acquired PE), inability to delay ejaculation, and negative personal consequences. Management includes behavioral and pharmacologic approaches. Aim: To systematically review effectiveness, safety, and robustness of evidence for complementary and alternative medicine in managing PE. Methods: Nine databases including Medline were searched through September 2015. Randomized controlled trials evaluating complementary and alternative medicine for PE were included. Main Outcome Measures: Studies were included if they reported on intravaginal ejaculatory latency time (IELT) and/or another validated PE measurement. Adverse effects were summarized. Results: Ten randomized controlled trials were included. Two assessed acupuncture, five assessed Chinese herbal medicine, one assessed Ayurvedic herbal medicine, and two assessed topical "severance secret" cream. Risk of bias was unclear in all studies because of unclear allocation concealment or blinding, and only five studies reported stopwatch-measured IELT. Acupuncture slightly increased IELT over placebo in one study (mean difference [MD] ¼ 0.55 minute, P ¼ .001). In another study, Ayurvedic herbal medicine slightly increased IELT over placebo (MD ¼ 0.80 minute, P ¼ .001). Topical severance secret cream increased IELT over placebo in two studies (MD ¼ 8.60 minutes, P < .001), although inclusion criteria were broad (IELT < 3 minutes). Three studies comparing Chinese herbal medicine with selective serotonin reuptake inhibitors (SSRIs) favored SSRIs (MD ¼ 1.01 minutes, P ¼ .02). However, combination treatment with Chinese medicine plus SSRIs improved IELT over SSRIs alone (two studies; MD ¼ 1.92 minutes, P < .00001) and over Chinese medicine alone (two studies; MD ¼ 2.52 minutes, P < .00001). Adverse effects were not consistently assessed but where reported were generally mild. Conclusion: There is preliminary evidence for the effectiveness of acupuncture, Chinese herbal medicine, Ayurvedic herbal medicine, and topical severance secret cream in improving IELT and other outcomes. However, results are based on clinically heterogeneous studies of unclear quality. There are sparse data on adverse effects or potential for drug interactions. Further well-conducted randomized controlled trials would be valuable. Cooper K, Martyn-St James M, Kaltenhaler E, et al. Complementary and Alternative Medicine for Management of Premature Ejaculation: A Systematic Review. Sex Med 2017;5:e1ee18.
Journal of Reproductive and Infant Psychology, 2020
Premna esculenta The present study was done to evaluate the hepatoprotective and the in vivo 4 di... more Premna esculenta The present study was done to evaluate the hepatoprotective and the in vivo 4 diluted Dunnett's t P 4 P P. esculenta showed a potential hepatoprotective activity and the protective action might have manifested by in liver disorders.
Introduction Klinefelter's syndrome is the most common chromosomal abnormality seen in men, a... more Introduction Klinefelter's syndrome is the most common chromosomal abnormality seen in men, affecting 1 in 650 men. It is a group of chromosomal disorders with at least one extra X chromosome (47, XXY) occurring due to non-disjunction at the time of gametogenesis. Most adult men are diagnosed at the time of fertility investigations. However, the syndrome has an array of clinical presentations which patients require input from numerous medical specialities during their lifetime. The setting up of a national-access Klinefelter Syndrome multidisciplinary clinic (KSMDT) approach comprising Urology, Endocrinology, Genetics, Reproductive medicine, Radiology, Psychosexual medicine, a specialist pharmacist as well as a patient representative has led to improvements in fertility and long- term management and waiting times. Here we describe the patient-reported outcomes and clinician perspectives of the clinic as it approached its 1st year. Method Between 2019 and 2020, 72 patients were s...
This chapter is mainly concerned with sexually transmitted infections and covers a range of issue... more This chapter is mainly concerned with sexually transmitted infections and covers a range of issues, including Chlamydia, gonorrhoea, hepatitis B and C, herpes, syphilis, and other vaginal infections such as Candida, Trichomonas vaginalis, and bacterial vaginitis. Each of these is taken separately with reference to a screening programme, if appropriate, clinical symptoms and appearance, diagnosis, the latest guidance on treatment, and considerations for pregnancy. Fetal and neonatal infections, congenital transmission, treatment, and surveillance options for the neonate, along with specific advice for the mother are also given.
Objective: To study the differences in sexual dysfunction and time to pregnancy (TTP) between inf... more Objective: To study the differences in sexual dysfunction and time to pregnancy (TTP) between infertile couples pursuing timed intercourse (TI – around the time of ovulation) and regular intercourse (RI – at least twice a week). Methods: In this prospective cohort study, we recruited all infertile couples presenting to the regional infertility clinics from January 2016 to December 2018, pursuing TI ( n = 283) or RI ( n = 88), and having no pre-existing sexual or psychiatric illness, and no medical contraindications to frequent intercourse. Sexual dysfunction was assessed using the Arizona Sexual Experience Scale and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The couples for whom natural conception was possible were followed up to determine TTP using Kaplan–Meier analysis. Results: TI significantly increased the risk of sexual dysfunction than RI for both males and females, even after adjusting for age, medical disorders, obesity, smoking, cause of infe...
This chapter covers problems that can occur with sexual health in women. It starts with the defin... more This chapter covers problems that can occur with sexual health in women. It starts with the definition, assessment, diagnosis, investigations, and treatment of different sorts of vaginal discharge. It provides information about sexual health in context, including its links with other forms of disease and psychological well-being. Protocols for partner notification in the cases of diagnosis with a sexually transmitted disease are explained. The signs, symptoms, and treatment for gonorrhea, chlamydia, and Mycoplasma genitalium are all covered. It also covers the definition, causes, diagnosis, and treatment of pelvic inflammatory disease. Hepatitis B and C are described, along with anogenital warts, genital herpes, and genital lumps and ulcers. Finally HIV and new developments such as PrEP and PEP are covered.
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Papers by Leila Frodsham