Emergency sperm extraction for transient erectile dysfunction prior to assisted conception

Purpose: During assisted conception treatment the male partner is under str ess and consequently can fail to produce semen sample prior to egg collecti on. Failure to produce spermatozoa at a given time could lend to cancellati on of the procedure. Methods: We report the use of emergency percutaneous epididymal sperm aspir ation (PESA) for temporary erectile dysfunction in a couple undergoing in v itro fertilization treatment. In the last 2 years, we saw three men who Sai led to produce a semen sample on the day of their partners' egg collection procedure. Results: In the first case the male partner failed to produce semen after e gg collection and the cycle was canceled. This clinical scenario was likely to recur and one of the options was to consider PESA. In the second case t he male partner was counseled about the availability of PESA but he managed to produce spermatozoa at home. The third patient was unable to produce a semen sample despite being provided audiovisual support and being allowed t o go home. Five hours after the egg collection, emergency PESA was performe d after appropriate counseling. The procedure yielded motile spermatozoa wh ich were used for intracytoplasmic sperm injection which resulted in succes sful fertilization, embryo transfer and pregnancy. Conclusions: This case emphasizes that surgical procedures, such as PESA, T ESA, and TESE, are useful alternatives but should be the last option to obt ain sperm for ART. Other nonsurgical procedures, such as audiovisual aids, producing sperm at home, and the use of sildenafil citrate (Viagra) must be offered first to men with temporary erectile dysfunction during ART treatm ent.