title: Successful pregnancies and healthy live births using frozen-thawed sperm retrieved by a new modified Hotchkiss procedure in males with retrograde ejaculation: first case series.
abstract: BACKGROUND
  In couples presenting with retrograde ejaculation refractory to medical treatment, the first choice of fertility treatment should be Assisted Reproductive Techniques using rapidly purified spermatozoa retrieved from post-ejaculatory urine. The Hotchkiss technique and modified variants are simple and efficient for retrieving sperm from the bladder. We developed a new protocol, including a novel modified Hotchkiss technique involving sperm cryopreservation. The aim was to study the pregnancy rate and birth rate achieved by intra cytoplasmic sperm injection (ICSI) using frozen-thawed sperm retrieved from the bladder with this novel modified Hotchkiss technique in patients with refractory retrograde ejaculation.
  
  
  RESULTS
  In this descriptive retrospective, single-center study, we analyzed the local database of all patients who banked sperm at the CECOS Laboratory Biology of Reproduction of La Conception University Hospital, Marseille, France, between 2004 and 2014. A total of 2171 patients banked sperm during this time, including 63 patients with retrograde ejaculation, of whom ten patients banked sperm that had been retrieved by the modified Hotchkiss technique. These ten couples underwent 26 ICSI cycles: nine clinical pregnancies were achieved in six couples, including eight after fresh embryo transfer and one after thawed embryo transfer, resulting in seven live births. The average live birth rate per transfer was 28 %.
  
  
  CONCLUSIONS
  We report the largest series of births using frozen-thawed spermatozoa retrieved from post-ejaculatory urine by a modified Hotchkiss technique. This series of births demonstrates that this new modified Hotchkiss technique allows for successful association with sperm cryopreservation, leading to an efficient and easy management of couples with refractory retrograde ejaculation.
authors.affiliation: AP-HM, La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, Centre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY, 13385 cedex 15 Marseille, France.
authors.forename: Melanie
authors.initials: M
authors.lastname: Philippon
authors.affiliation: Department of Urology, AP-HM La Conception, 147 bd Baille, 13385 Cedex 5 Marseille, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Karsenty
authors.affiliation: Neuro rehabilitation Unit, Leon Berard Hospital, bd du Dr Armanet, Hyères, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Bernuz
authors.affiliation: Pôle Femmes-Parents-Enfants, Centre clinico-biologique d'Assistance Médicale à la Procréation, AP-HM La Conception, 147 Bd Baille, 13 005 Marseille, France ; Institut Méditerranéen de Biodiversité et d'Ecologie Marine et Continentale (IMBE), CNRS - IRD, Aix Marseille Université, Univ-Avignon, Biogénotoxicologie, Santé Humaine et Environnement, 27, Boulevard Jean-Moulin, F-13385 Cedex 05 Marseille, France.
authors.forename: Blandine
authors.initials: B
authors.lastname: Courbiere
authors.affiliation: AP-HM, La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, Centre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY, 13385 cedex 15 Marseille, France ; Aix Marseille Université, CNRS, CRN2M UMR 7286, 13344 cedex 15 Marseille, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Brue
authors.affiliation: CECOS Laboratory Biology of Reproduction, Pôle Femmes-Parents-Enfants, 147 bd Baille, 13385 Cedex 5 Marseille, France.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Saïas-Magnan
authors.affiliation: Institut Méditerranéen de Biodiversité et d'Ecologie Marine et Continentale (IMBE), CNRS - IRD, Aix Marseille Université, Univ-Avignon, Biogénotoxicologie, Santé Humaine et Environnement, 27, Boulevard Jean-Moulin, F-13385 Cedex 05 Marseille, France ; CECOS Laboratory Biology of Reproduction, Pôle Femmes-Parents-Enfants, 147 bd Baille, 13385 Cedex 5 Marseille, France.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Perrin
keywords: Bladder; Diabetes; Male infertility; Post-thaw evaluation; Spinal cord injury