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Male infertility/Premature ejaculation

Presented by
Dr Jonathan Ramsay, Prof. Maarten Albersen, Dr Cath Mercer
EAU 2019
Novel approaches for assisted reproduction and pharmacological treatment of premature ejaculation.

On the topic of male infertility, Dr Jonathan Ramsay (London, United Kingdom) presented that sperm harvested directly from the testes of 63 men with evident infertility has the same DNA integrity/quality as ejaculated sperm of 76 healthy donor men. This is important to know because sperm from infertile men is often burdened by excessive DNA damage and this can cause troubles with the success rates of intracytoplasmic sperm injection and other forms of assisted reproduction techniques. In a comment from Prof. Maarten Albersen (Catholic University Leuven, Belgium) about this study, he warns: “However, we have to interpret these results with caution; certainly because they are now available in the lay press, association of course is not causation, and an adequate interventional design is needed to assess whether selection of certain patients with DNA damage with TESE [eds, Testicular/Epididymal Sperm Extraction] rather than using ejaculated sperm facilitates the success rates of assisted reproduction.”

Dr Cath Mercer et al. (University College London, United Kingdom) presented recent data supporting that serotonin is important in ejaculatory control in men [1]. We have long known from preclinical models that stimulation of serotonin 1A receptor 5-HT1A precipitates ejaculation [2]. However, despite data gathered from patients taking selective serotonin reuptake inhibitors (SSRIs) demonstrating modest effects on ejaculation latency time [3], interventional studies in humans have been lagging. At this conference, there was a new double-blind, placebo controlled phase 1 study presented with a new antagonist to this receptor (7 mg GSK958108 treatment group) that showed that intravaginal ejaculation latency time was shown to be 77% longer (95% CI 28%-144%). The main common adverse effect was headache, reported by 20%. Collectively, we can conclude that developments in premature ejaculation are finally translating to the clinic and we might see new drugs available in the near future.

Figure: Schematic overview of pathways controlling ejaculation

  1. Choi JB et al. J Urol. 2019 Jan;201(1):147-152.
  2. Arnone M et al. Behav Pharmacol. 1995 Apr;6(3):276-282.
  3. Sun Y et al. World J Urol. 2017 Dec;35(12):1817-1831.

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