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THE most memorable Argentine Tangos in history, from Jay McGuiness's effort to Jake Wood's bizarre performance. LOUISE REDKNAPP SINGER/TV PRESENTER. Louise Redknapp scores three tens for her "smoldering, sultry, stunning" Argentine Tango. Former singer Louise Redknapp will take on the first Argentine Tango of this year's Strictly as the competition heats up in week seven. I think Louise Redknapp will win. Watch this Strictly Come Dancing video, Louise Redknapp & Kevin Clifton Tango to 'Glad All Over' - Strictly 2016: Semi-Final, on Fanpop and browse other Strictly Come Dancing videos. Strictly Come Dancing's Louise Redknapp is set to dance the first Argentine Tango of the current series. Dancing the first (notoriously difficult) Argentine tango of the series, there was pressure for Louise Redknapp and partner Kevin Clifton to deliver. Louise and Kevin have been one point off a maximum on two occasions. WATCH: Louise Redknapp and Kevin Clifton Argentine Tango to 'Tanguera' on Strictly 2016 But now it is being claimed that the reason behind the split is because Louise was a contestant on last year's Strictly Come Dancing . The title of the show is a continuation of the long-running series Come Dancing, with an allusion to the film Strictly Ballroom. By Jessica Earnshaw PUBLISHED: 19:25, Fri, Nov 4, 2016 Find out more about Louise at her official website: www.louiseredknappofficial.co.uk Find out when Strictly Come Dancing: The Christmas Countdown is on TV. Dec 18, 2016 - Here are all of the pictures from the final of Strictly Come Dancing 2016 tonight. Former singer Louise and her professional partner Kevin Clifton performed a sizzling routine that had head judge Len Goodman raving that "there was nothing I … Strictly Come Dancing's Louise Redknapp is set to dance the first Argentine Tango of the current series. The former Hollyoaks actor scored an impressive 38 points – … Each couple is scored by a panel of judges. Louise's background in pop choreography and experience in judging BBC One's So You Think You Can Dance must have been of benefit when rehearsing for Strictly! BBC One - Strictly Come Dancing, Series 14, Week 7, Louise Redknapp and Kevin Clifton Argentine Tango to 'Tanguera' STRICTLY COME DANCING finalist Louise Redknapp almost turned BBC bosses down when she was asked to appear on the show. Abbey on this year's Strictly Come Dancing. Nov 7, 2016 - 212.4k Followers, 60 Following, 2,088 Posts - See Instagram photos and videos from BBC Strictly (@bbcstrictly) More information Did Louise Redknapp and Kevin Clifton 's sizzling Argentine Tango transport you to Buenos Aires? Strictly Come Dancing star Alexandra Burke will aim to outshine last year's finalist Louise Redknapp as she performs the first Argentine tango of the 2017 series. Ore Oduba and Louise are the only two celebrities to score 39 so far DANNY Mac topped the Strictly Come Dancing leader board on Saturday night after wowing the judges with an intense Argentine Tango. 'Strictly Come Dancing': Ore Oduba Stuns With Salsa Routine As Louise Redknapp Tops Leaderboard With Argentine Tango Even Ed Balls had a good night. Strictly Come Dancing: 8 of the best Argentine Tango routines ever Last updated: 7 November 2015 - 6.02pm Die-hard Strictly fans always have their favourite dance style, whether it be the powerful Paso Doble, the dynamic Jive or the romantic Waltz. Cue wincing sounds. LOUISE REDKNAPP proved she was very much a contender for the Strictly Come Dancing Glitterball trophy as she performed a 'passionate' Tango with partner Kevin Clifton tonight. Strictly Come Dancing Louise Redknapp - Louise Redknapp and Kevin Clifton danced a tango first in the semi-final Strictly Come Dancing Claudia Fragapane - Claudia Fragapane and … Louise started her career as one of the singers in the group Eternal, and a break to raise her two children, has continued her career as a television presenter, including two series as a judge on the BBC dance competition, So You Think You Can Dance. Louise Redknapp has flown to the top of the Strictly Come Dancing scoreboard after earning three 10s for her Argentine Tango, the first of the series. The popular routine is always eagerly awaited by Strictly fans and so here are seven of the most memorable efforts in the show's history. Louise Redknapp has flown to the top of the Strictly Come Dancing scoreboard after earning three 10s for her Argentine Tango, the first of the series. Three celebs went into this evening's show with Danny Mac, Louise. Strictly Come Dancing's Louise Redknapp has accidentally delivered an Argentinian tango kick to the centre of Kevin Clifton's manhood. Jay McGuiness and Aliona Vilani, 2015 (BBC/Guy Levy/PA) Following an impressive array of Halloween dances in last week's show, the remaining couples will battle it out for a place in … Image 6 This scored 39 (9,10,10,10) and is … Danny Mac and Oti Mabuse Argentine Tango to I Heard it Through the ... Week Eight Dances — Strictly Come Dancing, Series 14 ... Louise Redknapp … Louise Redknapp and Kevin Clifton Argentine Tango to 'Tanguera' - Strictly 2016: Week 7. Episode guide, trailer, review, preview, cast list and where to stream it on demand, on catch up and download. By Claire Corkery PUBLISHED: 18:07, Sat, Dec 17, … STRICTLY COME DANCING favourite and birthday girl Louise Redknapp made an embarrassing gaffe tonight during spin-off show, It Takes Two. 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redpajama_set_name: RedPajamaCommonCrawl


This article is about the municipality in Limburg. For the town in South Holland, see Valkenburg, South Holland.
Valkenburg aan de Geul (Dutch pronunciation: [ˌvɑlkə(m)bʏrx aːn də ˈɣøːl] ( listen); Limburgish: Valkeberg) is a municipality situated in the southeastern Dutch province of Limburg. The name refers to the central town in the municipality, Valkenburg, and the small river Geul.
Sieges and conquests have been the recurrent theme in the history of Valkenburg, especially in connection with Valkenburg castle, seat of the counts of Valkenburg (or Falkenburg). It was here that Beatrice of Falkenburg grew up, who, in 1269 at the age of 15, married 60-year-old Richard of Cornwall, king of the Holy Roman Empire. In December 1672 the castle was once again destroyed by Dutch troops led by William III, trying to prevent the armies of Louis XIV of France from capturing it, this time not to be rebuilt.
In the 19th century, because of the natural environment of the area, Valkenburg became a holiday destination for the well-to-do in the Netherlands. Tourism developed, especially after in 1853 the railway from Maastricht to Heerlen and Aachen opened. Valkenburg railway station is the oldest surviving station in the Netherlands. In the beginning of the 20th century, Dutch architect Pierre Cuypers lived in Valkenburg for several years. He helped develop tourism by designing a hotel, an open-air theater and a copy of the catacombs of Rome. He also restored the medieval church and designed several tombs and a chapel in Gothic Revival style in a graveyard situated on Cauberg, a steep hill outside the town center.
During the Second World War Valkenburg was occupied by Nazi-Germany for four years, four months and one week. The town was liberated on 17 September 1944 by the American 30th Infantry Division. For an overview of the resistance movement in Valkenburg during the war, see Valkenburg resistance.
Valkenburg is no longer a fortified town but it has largely retained its historical charm, although the town suffered heavily from mass tourism in the 1960s, 70s and 80s. The municipality of Valkenburg aan de Geul still hosts more than 1 million overnight stays a year. The present aim of the council of Valkenburg is to move away from mass tourism and emphasize "the natural and historical beauty of the town". In order to attract more "quality tourism" a plan was made called Vestingstad Valkenburg (Fortification Town Valkenburg). Included in the plan were the rebuilding of Geulpoort, a 14th-century city gate that was demolished along with the castle in the 17th century, the restoration of two other surviving city gates, and the reconstruction of the defensive moat along the Medieval wall in Halderpark. More or less simultaneously initiated was the redevelopment of the town's shopping district, to be finished in 2016.
Valkenburg aan de Geul is famous for its cycling events. The city has hosted the UCI Road Cycling World Championship a record five times, in 1938, 1948, 1979 and 1998 and again in 2012. Since 2003, the city's Cauberg hill has been the finish of the Amstel Gold Race. The Tour de France had a stage finish in Valkenburg in 1992 and in 2006.
The Cauberg Cyclo-cross is a cyclo-cross race and a part of the UCI Cyclo-cross World Cup.
Apart from the city of Valkenburg (including the neighbourhood of Broekhem), the municipality of Valkenburg aan de Geul comprises the following villages and hamlets: Berg en Terblijt, Vilt, Geulhem, Houthem, Sibbe, IJzeren, Oud-Valkenburg, Schin op Geul en Walem.
Valkenburg aan de Geul is served by the A79 motorway, this motorway runs from Maastricht to Heerlen.
Valkenburg aan de Geul has three train stations Valkenburg, Houthem-Sint Gerlach and Schin op Geul, operated by Arriva.
^ "College van B&W" [Board of mayor and aldermen] (in Dutch). Gemeente Valkenburg aan de Geul. Retrieved 2 December 2013.
^ "Postcodetool for 6301HC". Actueel Hoogtebestand Nederland (in Dutch). Het Waterschapshuis. Retrieved 2 December 2013.


The sci-fi anthology Silverthought: Ignition has been nominated for the IPPY (Independent Publishing) award for science fiction and fantasy for 2006. There are five finalist titles, and Silverthought: Ignition is one of them. The winner is going to be announced on May 10 (next wednesday).
For those just tuning in, Silverthought: Ignition is one of the first books published by Silverthought Press, of which I am an associate editor. Included in the book are two of my short stories "Cameron's Encyclopedia" and "The Cabana".
So, do me a favor and keep your fingers crossed. One of the other five finalists amazingly is also a Silverthought book, Broken the final book in Paul Hughes's sci-fi trilogy.


The July 2012 issue (Volume 5, Number 7) of the important journal Energy & Environmental Science will feature a cover story by Paul Dauenhauer of the Chemical Engineering Department. The title of the cover article is "Pyrolytic conversion of cellulose to fuels: levoglucosan deoxygenation via elimination and cyclization within molten biomass." As Dauenhauer explains the research described in his article, "In short, we discovered that wood, when heated, has a previously unknown second chemistry.
Dr. Bahram "Barry" and Mrs. Afsaneh Siadat of Miami Beach have pledged $150,000 over a five-year period to establish an Early Career Faculty Development Award for supporting the research program of an untenured faculty member in the Chemical Engineering (ChE) Department at UMass Amherst. Strong preference will be given to faculty working in the broad field of bioengineering, a strategic growth area for the department and the College of Engineering that aims at developing revolutionary technologies to improve the quality of human life.
Chemical Engineering (ChE) alumna Rena Bizios '68 recently lectured here on "Strategies to Promote Mammalian Cell Functions Pertinent to New Tissue Formation for Biomedical Applications." It was a great opportunity for the ChE department to renew old and warm acquaintances with a former student who has excelled in her field. The highly accomplished Dr. Bizios is currently the Peter T. Flawn Professor in the Department of Biomedical Engineering at the University of Texas at San Antonio. Dr.
Talented and accomplished students from all four departments at the College of Engineering have won numerous awards, scholarships, fellowships, and other distinctions this semester on the national, regional, and campus level. They range from the prestigious National Science Foundation's Graduate Research Fellowship, competing against the best undergraduates in the nation, to a host of awards presented by the chancellor.
A team led by Paul Dauenhauer of the Chemical Engineering Department has discovered a new, high-yield method of producing the key ingredient used to make recyclable plastic bottles from biomass. The process is inexpensive and currently creates the chemical p-xylene with an efficient yield of 75-percent, using most of the biomass feedstock. The research is published in the journal ACS Catalysis. Dauenhauer says the new discovery shows that there is an efficient, renewable way to produce a chemical that has immediate and recognizable use for consumers.
On April 20 and 21, the University of Massachusetts Amherst will host the Northeast Regional Meeting of the National Organization for the Professional Advancement of Black Chemists and Chemical Engineers (NOBCChE). The conference theme will be "Nanotech: Novel Applications and New Opportunities in Technology, Engineering, and Chemistry." The conference will be held on April 20 on the 10th floor of the UMass Campus Center, and on April 21 in the Integrated Science Building.
Chemical engineering undergraduates Kathryn Geldart and Sarena Horava have both received one of the country's most highly sought-after fellowships, the National Science Foundation's Graduate Research Fellowship, worth more than $40,000 annually for three years. The fellowship is based on each candidate's overall undergraduate record, including academics, research experience, internships, awards, publications, college activities, and a research proposal based on the kind of work that might be conducted in graduate school.
Robert Coolman, a graduate student in chemical engineering in the research laboratory of George Huber, discussed his research on building and using biofuels reactions to create green gasoline and critical industrial petrochemicals during a long interview on Livescience.com, a website supported by the National Science Foundation to publicize its funded research. Using a combination of experiments and mathematical models, Coolman designs and builds biofuel reactors and studies how the chemicals that make up plants interact with catalysts to form fuel.
On Thursday, April 12, from 6:00 p.m. until 8:00 p.m., the Boston Globe and the University of Massachusetts Amherst will present a program on climate change entitled "Global Warning!" that features national biofuels expert, researcher, and activist Dr. George Huber of our Chemical Engineering Department. The evening will include a scientific panel on "What is Climate Change?" and a second panel on "How Can We Prevent Climate Change?" The program will take place in the Rabb Lecture Hall of the Boston Public Library, 700 Boylston Street in Boston, and space is limited.


text:
Best Practices Statements
Other Clinical Guidance
Home Guidelines Best Practices Statements Obstructive Azoospermia: Best Practice Statement
The Management of Obstructive Azoospermia
Reviewed and Validity Confirmed 2011
Unabridged version of this best practice statement [pdf]
Panel Members
Jonathan Jarow, MD, Chairman; Mark Sigman, MD, Facilitator; Peter N. Kolettis, FMD; Larry R. Lipshultz, MD; R. Dale McClure, MD; Ajay K. Nangia, MD; Cathy Kim Naughton, MD; Gail S. Prins, PhD; Jay I. Sandlow, MD; Peter N. Schlegel, MD
Azoospermia, defined as complete absence of sperm from the ejaculate, is present in less than 2% of all men1 and in 15% of infertile men.2 Although there are many causes of azoospermia, obstruction of the ductal system is responsible for approximately 40% of cases.2 Obstructive azoospermia may result from epididymal, vasal, or ejaculatory duct pathology. Vasectomy is the most common cause of vasal obstruction. Severe genitourinary infections, iatrogenic injury during scrotal or inguinal surgical procedures and congenital anomalies are other common causes of obstructive azoospermia.
A limited evaluation of both partners is important before reaching a final decision on the management of the couple with infertility due to obstructive azoospermia. Other factors either unrelated or indirectly related to the obstruction may play a role in the decision regarding management. For instance, congenital bilateral absence of the vasa deferentia (CBAVD) is a common cause of obstructive azoospermia and is associated with mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene.3 Genetic testing and counseling should be considered in the management of these couples prior to treatment to allow the couple to make an informed decision as to whether or not to use the husband's sperm. Since female factors may also play a role, the female partner should be offered at least a limited evaluation prior to treatment of the infertile couple with obstructive azoospermia.
This review offers recommendations for management of couples with infertility due to obstructive azoospermia.
This best practice statement, Management of Obstructive Azoospermia, is part of an updated series on male infertility prepared by the Male Infertility Best Practice Statement Panel (Appendix 1). Other titles include: Best Practice Statement on the Optimal Evaluation of the Infertile Male, Best Practice Statement on Evaluation of the Azoospermic Male, and Best Practice Statement on Varicocele and Infertility. The first editions (2001) of these 4 reports were prepared by the Male Infertility Best Practice Policy Committee of the American Urological Association, Inc.® (AUA; Appendix 1) and the Practice Committee of the American Society for Reproductive Medicine. The two organizations agreed to collaborate to prepare documents of importance in the field of male infertility.
In October 2007, an updated assessment of the literature on male infertility by the AUA Practice Guidelines Committee (PGC) found insufficient outcomes data to support a formal meta-analysis and an evidence-based guideline. The evidence was generally of a low level, being derived overwhelmingly from nonrandomized studies. Thus, the Male Infertility Best Practice Statement Panel, which included many of the members of the 2001 Committee, was created by the Board of Directors (BOD) of the AUA. The Panel was charged with developing a best practice statement, based on the previous report, by employing published data in concert with expert opinion. The Panel co-chairmen and members were selected by the PGC. The mission of the Panel was to develop recommendations, based on expert opinion, for optimal clinical practices in the diagnosis and treatment of male infertility. It was not the intention of the Panel to produce a comprehensive treatise on male infertility.
The initial Medline search that spanned 1999 through October 2007 was supplemented by review of bibliographies and additional focused searches. In all, 341 articles were deemed by the Panel members to be suitable for scrutiny. Three of the four original 2001 reports were updated with new findings and are presented in the documents in colored font. This updated document was submitted for peer review, and comments from 21 physicians and researchers were considered by the Panel in making revisions. The final document has been approved by the AUA PGC and the BOD. Funding of the Panel was provided by the AUA; members received no remuneration for their work. Each Panel member provided a conflict of interest disclosure to the AUA.
Treatment methods for obstructive azoospermia
Men with obstructive azoospermia may father children either by 1) surgical correction of the obstruction, which may produce pregnancy by intercourse and obviate the need for assisted reproductive technology; or 2) retrieval of sperm from the male reproductive system for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI).
Surgical correction may be accomplished by microsurgical reconstruction of the vas and/or epididymis or, in cases of ejaculatory duct obstruction, by transurethral resection of the ejaculatory ducts (TURED). Prior to performing microsurgery in the male, the female partner should be evaluated to determine if female infertility factors are present.
Microsurgical reconstruction of the reproductive tract
Microsurgical reconstruction of the reproductive tract often is successful in patients with obstructive azoospermia. Following vasectomy reversal, for example, return of sperm to the ejaculate occurs in 70-95% of patients, and pregnancies are obtained without the need for assisted reproduction in 30-75% of couples. A very important factor influencing the likelihood of sperm returning to the semen and of pregnancy after vasectomy reversal is the number of years between vasectomy and attempted reconstruction.4 The length of the obstructive interval and the chance for successful outcome of vasectomy reversal are inversely related. Other factors influencing the success of vasectomy reversal include: the presence or absence of sperm in the intraoperative vas fluid; the gross appearance of the vas fluid; the quality of the sperm in the vas fluid; the length of the vas segment between the epididymis and the vasectomy site; and the presence or absence of a sperm granuloma at the vasectomy site. The likelihood of pregnancy after vasectomy reversal is also heavily influenced by the age of the female partner.
Vasoepididymostomy is performed for congenital, infectious, postvasectomy or idiopathic epididymal obstruction. Following this type of microsurgery, 20-40% of couples achieve pregnancy through intercourse. Accuracy and delicacy of microsurgical technique affect the outcome of reconstructive procedures on the male reproductive system. The best results are achieved by surgeons with training and on-going experience in microsurgery. In order to maximize successful outcomes, surgeons performing vasectomy reversal should be comfortable with anastomoses involving extremely small luminal diameters and must be competent and comfortable with both vasovasostomy and vasoepididymostomy, because the latter may be unexpectedly necessary in many cases.
In rare cases, obstruction of the male reproductive tract occurs in the inguinal portion of the vas deferens. Obstruction in this location is usually caused by an injury to the vas during inguinal hernia repair and should be considered in azoospermic men who have a history of previous inguinal surgery. Some of these injuries can be corrected by vasovasostomy performed in the inguinal canal, provided that the ends of the vas can be located and approximated without tension.
Sperm retrieval and cryopreservation may be performed at the time of microsurgical reconstruction in order to avoid a second procedure in the event that the microsurgical reconstruction does not reverse a patient's azoospermia.
Transurethral resection of the ejaculatory ducts
The possibility of ejaculatory duct obstruction should be considered in the differential diagnosis of obstructive azoospermia. This condition is uncommon, but can be treated by transurethral resection of the ejaculatory duct at the point where the duct enters the distal prostatic urethra near the veru montanum. Transurethral resection of the ejaculatory duct results in the appearance of sperm in the ejaculate in about one-half to three-fourths of cases. The pregnancy rate achieved by this surgery is about 25%.
Sperm retrieval techniques and in vitro fertilization/intracytoplasmic sperm injection
Intracytoplasmic sperm injection
Intracytoplasmic sperm injection is an adjunct to standard IVF. ICSI must be used in almost all cases in which sperm are retrieved from the testes or epididymides of a man with obstructive azoospermia, because the sperm retrieval techniques that must be employed to obtain sperm from these men very rarely produce enough motile sperm for intrauterine insemination (IUI) or standard IVF.5-6 ICSI provides fertilization rates of 45-75% per injected oocyte when surgically retrieved epididymal or testicular spermatozoa are used.7-13 Clinical pregnancy rates reported in the recent literature range from 26-57% and delivery rates range from 18- 75%.9-13At most reproductive centers, it is reasonable to expect clinical pregnancy rates of 30-40% and delivery rates of 25-30% when surgically retrieved epididymal or testicular sperm are used for ICSI.
In reproductive centers managing men with obstructive azoospermia, it is essential for the IVF team to have ICSI capability. Individuals with specific clinical and technical expertise must be available for all of the phases of IVF/ICSI. Sperm retrieval is best performed by a surgeon trained in this procedure, because the possible postoperative complications of sperm retrieval include bleeding and infection may require surgical intervention.
Sperm retrieval
Sperm retrieval for use in assistive reproductive techniques may be viewed as primary treatment for obstructive and nonobstructive azoospermia, or as an adjunct to microsurgical reconstructive procedures in cases of obstructive azoospermia. Common methods of sperm retrieval are listed in Table 1.14 The goals of sperm retrieval are to obtain the best quality sperm possible in adequate numbers for immediate use and/or potential cryopreservation while minimizing the damage to the reproductive tract. The choice of sperm retrieval method depends primarily on the experience and preference of both the physician who performs the retrieval and the IVF laboratory embryologist who will be handling the specimen. There is not adequate evidence that either fertilization or pregnancy rates are different using either fresh or thawed cryopreserved sperm from patients with either obstructive or nonobstructive azoospermia.15-16 Therefore, the timing of sperm retrieval in relation to oocyte retrieval should be based upon local preferences and expertise.
Table 1 : Obstructive Azoospermia: Sperm Retrieval Techniques
Microsurgical epididymal sperm aspiration (MESA)
Large quantity of sperm obtained suitable for several IVF/ICSI cycles in one procedure
Requires microsurgical skills
Incision with post-op discomfort
Higher cost compared to percutaneous procedures
Percutaneous epididymal sperm aspiration (PESA)
No microsurgical skills required
Minimum post-op discomfort
Fewer sperm retrieved
Risk of epididymal damage
Testicular sperm extraction
(TESE) and microTESE
No microsurgical skills required except when micro TESE performed
Risk of testicular damage with multiple biopsies
Percutaneous testicular sperm aspiration (TESA)
Open surgical testicular sperm retrieval with (TESE) or without microscopic magnification (microTESE) is recommended for patients with nonobstructive azoospermia. In contrast, there is not adequate evidence that the source or method of sperm harvesting affects the outcome of IVF with ICSI for patients with obstructive azoospermia.17-18 Thus, the choice of sperm retrieval by either percutaneous or open surgery from either the testis or epididymis should be based upon local preferences and expertise.
Sperm retrieval may be performed sometime before or on the same day as the oocyte retrieval from the female partner. Many laboratories prefer to use freshly retrieved sperm rather then cryopreserved sperm, although there is no substantial evidence to indicate that fresh sperm yield superior results. Fresh sperm may be preferable for patients with nonobstructive azoospermia and very few sperm harvested because of the concern that there may not be any viable sperm available upon thawing. However, for logistical and financial reasons, it's often preferable to harvest and cryopreserve sperm well in advance of the oocyte retrieval since there is the possibility that no sperm will be obtained. This avoids putting the wife through superovulation unnecessarily.
1. The timing of sperm retrieval in relation to oocyte retrieval should be based upon local preference and expertise because there is no evidence that either fertilization or pregnancy rates are different using either fresh or thawed cryopreserved sperm from patients with either obstructive or nonobstructive azoospermia.
2. The choice of sperm retrieval by either percutaneous or open surgery from either the testis or epididymis should be based upon local preferences and expertise since there is no evidence that the site or method of sperm retrieval affects outcome of in vitro fertilization with intracytoplasmic sperm injection for patients with obstructive azoospermia.
3. Open surgical testicular sperm retrieval with or without microscopic magnification is recommended for patients with nonobstructive azoospermia.
Risks associated with IVF/ICSI
Any couple considering IVF/ICSI should be apprised of the risks associated with this treatment. These risks include the possibility of ovarian hyperstimulation, the potential complications of oocyte retrieval and multiple gestations.19 The risk of congenital malformations in children conceived after ICSI, compared to results after IVF, have yielded conflicting results. Meta- analysis of studies after assisted reproductive treatments (IVF or ICSI) suggest less than 30% increase in the risk of congenital malformations relative to the rate of malformations in children conceived naturally (1-4% rate of malformations).20 This information should be shared with couples considering IVF with or without ICSI. The prevalence of sex chromosome abnormalities in children conceived by ICSI is higher than that observed after routine IVF (0.8- 1.0% vs. 0.2%). It is unclear whether this apparent increased risk results from the ICSI procedure or from a paternal effect related to abnormal sperm production in the male requiring ICSI.21
IVF carries a risk of mild ovarian hyperstimulation syndrome in up to 20% of patients. Moderate ovarian hyperstimulation occurs in up to 5% of women undergoing IVF. Severe ovarian hyperstimulation, which may require hospitalization and can be life threatening, occurs in 1% of women undergoing IVF.22
The risk of multiple gestations after ICSI in the United States is approximately 30% for twin gestations and less than 5% for triplets.23 Multiple-gestation births are associated with increased infant morbidity and mortality rates due primarily to prematurity.24 The neonatal and maternal morbidity induced by multiple gestations accounts for the increased perinatal expense associated with multiple gestations. Whereas the in-hospital costs for delivery of a singleton child are typi- cally less than $10,000, perinatal care for triplets averages more than $100,000.25
Microsurgical reconstruction versus sperm retrieval with IVF/ICSI
Microsurgical vasovasostomy26 and vasoepididymostomy27 have been shown to be more cost- effective than sperm retrieval with IVF/ICSI, which requires intervention in both the male and female. In addition, microsurgical reconstruction, if successful, allows couples to have subsequent children without additional medical treatment. Therefore, in most cases, microsurgical reconstruction is more appropriate as an initial treatment for obstructive azoospermia.
There are situations, however, where sperm retrieval with IVF/ICSI may be the method of choice for couples in which the male has obstructive azoospermia. Financial factors are a legitimate concern in the management of this problem and may dictate the ultimate choice in treatment. If the situation involves a possible vasovasostomy, then the time that has elapsed since the vasectomy should also be taken into account. Sperm retrieval with ICSI may be preferable if the duration of obstruction is long. Pregnancy occurs in only 30% of couples managed by vasectormy reversal when the obstructive interval is greater than 15 years.4
Female infertility factors might also favor the selection of IVF/ICSI. The fertility status of the female partner is related to the presence or absence of specific risk factors, such as endometriosis or ovulatory dysfunction, and to age. When the female partner has tubal disease or has undergone tubal ligation, sperm retrieval with IVF/ICSI is clearly preferable because it avoids subjecting both partners to reconstructive microsurgery. The woman's age is important because a woman's fertility progressively decreases after age 35 years and is limited after age 40 years.28
Due to the fact that the average interval until pregnancy after a successful microsurgical vasectomy reversal is 12 months4, couples may consider sperm retrieval with ICSI when the female partner is greater than 37 years of age. However, in couples in which the female partner approaches age 40, the success rate of IVF with or without ICSI decreases dramatically as well.23
Older women should be evaluated before any fertility treatment is undertaken. The choice of either sperm retrieval with IVF/ICSI or microsurgical reconstruction should also be influenced by the pregnancy rates achieved with ICSI by the IVF team when epididymal or testicular sperm is used and by the surgeon's results with microsurgical reconstructive procedures.
The final decision concerning microsurgical reconstruction versus sperm retrieval with IVF/ICSI is ideally made by the well-informed couple together with both partners' reproductive specialists.
Recommendations: Microsurgical reconstruction of the reproductive tract is preferable to sperm retrieval with in vitro fertilization/intracytoplasmic sperm injection in men with prior vasectomy if the obstructive interval is less than 15 years and no female fertility risk factors are present. If epididymal obstruction is present, the decision to use either microsurgical reconstruction or sperm retrieval with in vitro fertilization/intracytoplasmic sperm injection should be individualized. Vasoepididymostomy should be performed by an expert in reproductive microsurgery.
Sperm retrieval/ICSI is preferred to surgical treatment when (1) advanced female age is present, (2) female factors requiring IVF are present (3) the chance for success with sperm retrieval/ICSI exceeds the chance for success with surgical treatment or (4) sperm retrieval/ICSI is preferred by the couple for financial reasons.
AQUA 19: Diagnosis of Type od Azoospermia and Diagnostic Testing for Obstructive Azoospermia [pdf]
AQUA 20: Genetic testing of the Azoospermic male [pdf]
AQUA 21: Appropriate management of obstructive Azoospermia [pdf]
1. Willott GM: Frequency of azoospermia. For Sci Inter 1982; 20: 9.
2. Jarow JP, Espeland MA, and Lipshultz LI: Evaluation of the azoospermic patient. J Urol 1989; 142:162.
3. Anguiano A, Oates RD, Amos JA et al: Congenital bilateral absence of the vas deferens. A primarily genital form of cystic fibrosis. JAMA 1992; 267:1794.
4. Belker AM, Thomas AJ Jr, Fuchs EF et al: Results of 1,469 microsurgical vasectomy reversals by the vasovasostomy study group. J Urol 1991; 145:505.
5. Silber SJ, Nagy ZP, Liu J et al. Conventional in-vitro fertilization versus intracytoplasmic sperm injection for patients requiring microsurgical sperm aspiration. Hum Reprod 1994; 9: 1705.
6. Schlegel PN, Palermo GD, Alikani M et al: Micropuncture retrieval of epididymal sperm with IVF: Importance of in vitro micromanipulation techniques. Urol 1995; 46:238.
7. Nagy Z, Liu J, Cecile J et al: Using ejaculated, fresh and frozen-thawed epididymal spermatozoa gives rise to comparable results after ICSI. Fertil Steril 1995; 63:808.
8. Gil-Salom M, Minguez Y, Rubio C et al: Efficacy of intracytoplasmic sperm injection using testicular spermatozoa. Hum Reprod 1995; 10:3166.
9. Tournaye H, Merdad T, Silber S et al. No difference in outcome after intracytoplasmic sperm injection with fresh or with frozen-thawed epididymal spermatozoa. Hum Reprod 1999; 14: 90.
10. Palermo GD, Schlegel PN, Hariprashad JJ et al. Fertilization and pregnancy outcome with intracytoplasmic sperm injection for azoospermic men. Hum Reprod 1999; 14: 741.
11. Kupker W, Schlegel PN, Al-Hasani S et al. Use of frozen-thawed testicular sperm for intracytoplasmic sperm injection. Fertil Steril 2000; 73:453.
12. Habermann H, Seo R, Cieslak, J et al: In vitro fertilization outcomes after intracytoplasmic sperm injection with fresh or frozen-thawed testicular spermatozoa. Fertil Steril 2000; 73: 955.
13. Mercan R, Urman B, Alatas C et al. Outcome of testicular sperm retrieval procedures in non-obstructive azoospermia: percutaneous aspiration versus open biopsy. Hum Reprod 2000; 15: 1548.
14. Practice Committee of the American Society for Reproductive Medicine. New techniques for sperm acquisition in obstructive azoospermia. Fertil Steril 2004;82 Suppl 1:S186.
15. Verheyen G, Vernaeve V, Van Landuyt L et al: Should diagnostic testicular sperm retrieval followed by cryopreservation for later ICSI be the procedure of choice for all patients with non-obstructive azoospermia? Hum Reprod. 2004; 19: 2822.
16. Wald M, Ross LS, Prins GS et al: Analysis of outcomes of cryopreserved surgically retrieved sperm for IVF/ICSI. J Andrology 2006; 27: 60.
17. Nicopoullos JD, Gilling-Smith C, Almeida PA et al: Use of surgical sperm retrieval in azoospermic men: a meta-analysis. Fertil Steril. 2004; 82:691.
18. Schwartzer JU, Fiedler K, v Hertwi I et al: Sperm retrieval procedures and intracytoplasmatic spermatozoa injection with epididymal and testicular sperms. Urol Int. 2003; 70: 119.
19. Schlegel PN and Girardi SK: Clinical review 87: In vitro fertilization for male factor infertility. J Clin Endocrinol Metab 1997; 82:709.
20. Hansen M, Bowen C, Milner E et al: Assisted reproductive technologies and the risk of birth defects—a systematic review. Hum Reprod 2005; 20: 328.
21. Bonduelle M, Van Assche E, Joris H et al: Prenatal testing in ICSI pregnancies: incidence of chromosomal anomalies in 1586 karyotypes and relation to sperm parameters. Hum Reprod 2002; 17:2600.
22. Bassil S, Godin PA, Stallaert S et al. Ovarian hyperstimulation syndrome. A review. Assist Reprod Rev 1995; 5: 90.
23. Department of Health and Human Services, Centers for Disease Control and Prevention. Available at: http://cdc.gov/art/
24. Wilcox LS, Keily JL, Melvin CL et al: Assisted reproductive technologies: estimates of their contribution to multiple births and newborn hospital days in the United States. Fertil Steril 1996; 65: 361.
25. Callahan TL, Hall JE, Ettner SL et al: The economic impact of multiple gestation pregnancies and the contribution of assisted reproduction techniques to their incidence. New Engl J Med 1994; 331:244.
26. Pavlovich CP and Schlegel PN: Fertility options after vasectomy: A cost-effectiveness analysis. Fertil Steril 1997; 67:133.
27. Kolettis PN and Thomas AJ: Vasoepididymostomy for vasectomy reversal: a critical assessment in the era of intracytoplasmic sperm injection. J Urol 1997; 158:467.
28. Hull MGR, Fleming CF, Hughes AO et al. The age-related decline in female fecundity: a quantitative controlled study of implanting capacity and survival of individual embryos after in vitro fertilization. Fertil Steril 1996; 65:783.
AUA American Urological Association
BOD Board of Directors
CBAVD congenital bilateral absence of the vasa deferentia
CFTR cystic fibrosis transmembrane conductance regulator
ICSI intracytoplasmic sperm injection
IUI intrauterine insemination
IVF in vitro fertilization
MESA microsurgical epididymal sperm aspiration
PESA percutaneous epididymal sperm aspiration
PGC Practice Guidelines Committee
TEFNA testicular fine-needle aspiration
TESA percutaneous testicular sperm aspiration
TESE testicular sperm extraction
TURED transurethral resection of the ejaculatory ducts
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Inspire Bingle: Who decides how fast you go?
I was recently standing around talking with a group of people. One of them talked about driving during a recent trip. His speedometer stopped working while he drove down an interstate so he had no idea of how fast or slow he was going.
"What did you do?" someone asked.
"I just kept driving," he said.
And you know, that's what a lot of us do with life. You may let other people—at work or home or the Jones family next door—set your pace, determine your actions, choose your sense of right and wrong. Try letting God set your pace as you listen to life and make a life, not just a living.


Pakistan's ban on two terrorist groups will not affect the activities of separatists in Jammu and Kashmir, Online quotes a former spy master as saying. Hamid Gul, former chief of ISI, said the groups were "natural allies" of the Pakistan army and in any conventional war with India would join hands with the armed forces, the news agency says.
The Pakistan Government has released some of the detained activists of the banned militant organisations after scrutiny, media reports said today. Reports from Karachi said that over 400 members of the militant groups, including that of the Jaish-e-Mohammad and Lashkar-e-Toiba blamed for the attack on the Indian Parliament were arrested till yesterday.
Islamic groups banned in Pakistan for preaching and exporting militancy cannot reappear under new names, an official statement published today said.
Sri Lanka today dismantled seven-year-old restrictions on movement of essential goods to the LTTE-controlled northern Vanni region, when it despatched 30 truck loads of supplies in a major move to earn the trust of the minority Tamils.
Human Rights groups fearful for the rights of prisoners captured in Afghanistan by US forces have an unusual pitch with which to lobby Western governments: some of the men being held are your own.
Taliban supporters in Dhaka Cabinet?
Bangladesh Nationalist Party (BNP)-led coalition government of Ms Khaleda Zia is embarrassed by the irrefutable allegation by the opposition leader Ms Sheikh Hasina that the Taliban supporters are being given berth in the Cabinet.
The Bush administration has urged Israel to defer selling weapons technology to India in the light of the current crisis with Pakistan, a senior US official said today.
Iranian reformist Parliament deputy Hossein Loqmanian waves to well wishers as he leaves Tehran's Evin prison on Tuesday. Iran's supreme leader Ayatollah Ali Khamenei agreed to defuse a row with Parliament and pardon Loqmanian after Parliament Speaker Mehdi Karroubi's declaration in an emotional speech that he would boycott the legislature until the outspoken Loqmanian was freed.
Lacking uniforms, boots and with few arms, new recruits of Brigade 7, the new military training academy near Kandahar, Afghanistan, march in formation, on Sunday. The men are to be incorporated into both a provincial force and a national Afghan army. Afghanistan has no formal army and creating a national force is the top priority of interim Prime Minister Hamid Karzai.
Members of the media have been given access to the site where police officials are sorting through debris from the World Trade Center.
Pakistan's ban on two terrorist groups will not affect the activities of separatists in Jammu and Kashmir, Online quotes a former spy master as saying.
Hamid Gul, former chief of ISI, said the groups were "natural allies" of the Pakistan army and in any conventional war with India would join hands with the armed forces, the news agency says.
He said there would be no effect on what he termed the "freedom movement" in Jammu and Kashmir following the ban on LeT and JeM groups as they had a strong and indigenous network in the Kashmir valley.
Pakistan President Pervez Musharraf banned the two groups on Saturday following intense pressure from the USA to crackdown on terrorist groups active in Pakistan.
Gul admitted the ban was due to "immense" US pressure on President Musharraf. "There is no justification for banning the jehadi groups. The decision has been taken only to entertain the demand of the Bush administration.
"Now the ball is in US' court. If it wants to stem the growing jehadi culture among Muslim youths, it has to put pressure on India for a solution of the Kashmir dispute," Gul said.
"If India does not desist from its current policies towards Pakistan, President Musharraf will have no other option but to declare jehad, which, according to him, only a state can declare," Gul contended.
Gul, who is widely seen as anti-US, is a known supporter of militant groups active in India.
MUZAFFARABAD: The LeT has vowed to continue the freedom struggle in Kashmir in spite of it being banned by the Pakistan, Online reports.
A LeT spokesman said in a statement that the ban on the group was harmful to the Kashmir cause.
"It would have been better if the government had taken the ground realities into account before imposing the ban on us.
The decision has adversely affected the moral of (those) who are fighting for the legitimate right of self determination in accordance with the UN charter", the spokesman added.
The Pakistan Government has released some of the detained activists of the banned militant organisations after scrutiny, media reports said today. Reports from Karachi said that over 400 members of the militant groups, including that of the Jaish-e-Mohammad and Lashkar-e-Toiba blamed for the attack on the Indian Parliament were arrested till yesterday. According to a report in the daily, Dawn, some of them have been released yesterday after scrutiny.
Confusion reigned supreme over the numbers arrested. While some reports put the total number of arrests between 1,300 to 1,600, others quoted Pakistan's Interior Secretary Tasneem Noorani as saying that over 1,400 members were arrested and 390 offices sealed.
Newspapers and magazines extolling the virtues of Islamic holy war in Kashmir still clutter the news stands in Pakistan despite the military government's sweeping crackdown on extremism.
But the two groups, Lashkar-e-Toiba and Jaish-e-Mohammad, are still spreading their message through a range of publications and magazines easily available here.
It said anyone attempting that would invite action under the Anti-Terrorism Act (ATA) as amended by the military government, in August, last year, at the start of its campaign to curb religious violence and terrorism in the Muslim country.
The government issued the statement after one of the five banned parties, the Tehrik-e-Jafria Pakistan Party of the minority Shiite community, announced in the Press that it would continue functioning under the new name of Millat-e-Jafria Pakistan.
The statement reminded the Press that dissemination of any statement on behalf of a banned party is prohibited and punishable under the ATA.
According to the newspaper, Dawn, the Act allows the banned party to seek a review of the ban or apply for lifting it after three years.
Meanwhile, Pakistan said yesterday that India's reaction to President Pervez Musharraf's speech was not negative, but that Islamabad had expected a "warmer response," Online reports.
"We certainly expected a warmer response but the Indian reaction cannot be termed as negative", Foreign Office spokesman Kamran Niaz said at a joint news briefing with the President's press spokesman, Major-Gen Rashid Qureshi.
"We reject the Indian assertion that they do not accept the UN resolutions (on Kashmir). The issue has to be discussed under the same resolution and if India is not ready for a third-party role, it is their choice", he said in reply to a question.
India has said that the U.N. resolutions on Kashmir have outlived their utility.
Government ministers were present when the convoy of trucks, carrying food, medicines, building materials, farm equipment and fertilisers, moved out from the Piramanalamkulam check-point, the last army post in Vavuniya district, into rebel-held areas.
With this, the United National Party-led regime of Prime Minister Ranil Wickremesinghe has initiated action on an election promise to Tamils to create normality in the north before opening talks with the LTTE.
Years of military conflict had led to the government imposing what Tamils called an economic embargo on their homeland, but supplies in limited quantities were being maintained all along through the war years.
After announcing a reciprocal cessation of hostilities late last month in response to the LTTE's unilateral one-month ceasefire, the government also decided to remove the restrictions but still maintains a small list of banned items like fire-arms, explosive substances, electronic remote-control equipment, binoculars and small batteries.
Rehabilitation, Reconstruction and Refugees Minister Jayalath Jayawardena, who was present along with Interior Minister John Amaratunga in Vavuniya today, said 120 truck loads of supplies would be sent every week, with 30 trucks plying on four days.
Officials said 11 trucks went to Kilinochchi, 13 to Mullaitivu, four to Madhu and Pandivirichan in the Mannar area and two to Nedunkerni, all areas reeling under severe shortages for years.
The relaxation of economic restrictions is considered a major step in the peace process that has gathered momentum with the observance of a mutually-agreed temporary truce for the first time since 1995.
A US Air Force C-141 aircraft arrives US Naval base in Guantanamo Bay, Cuba, bringing in a second group of Taliban and al Qaida prisoners from Afghanistan on Monday.
Along with hundreds of Arabs and Afghans, the USA has rounded up at least one Briton, two Frenchmen, an American and an Australian in its "war on terror'', with some detained for interrogation at a US naval base in Cuba.
At least one of the Europeans has already arrived in Cuba, with others expected to follow suit in coming days.
Campaigners expressed concern yesterday about the living conditions at the Guantanamo Bay prison camp, their status and about the legality of holding men without access to consular staff.
"The USA is flouting international rules of law,'' international legal rights campaigner Stephen Jakobi, Director of London-based Fair Trials Abroad, told Reuters.
Jakobi said he would address the European Parliament in the next few days to encourage European governments to pressure the USA into abiding by international law.
Bangladesh Nationalist Party (BNP)-led coalition government of Ms Khaleda Zia is embarrassed by the irrefutable allegation by the opposition leader Ms Sheikh Hasina that the Taliban supporters are being given berth in the Cabinet. Even the visiting foreign dignitaries were given to understand that the Cabinet included two supporters of former Taliban government in Afghanistan. Ms Zia without showing any concern asked the Opposition the names of the Taliban supporters. After that the government has been maintaining silence while the Opposition cries hoarse.
Leader of the Opposition in parliament during her meeting with a two- member delegation of the US Congress on Monday briefed them that two known supporters of the Taliban forces found berth in the Cabinet of the Khaleda Zia-led coalition government. She made the allegation when she called on US Congressman Joseph Crowley and James McDermott, Chairman and senior member of the Congressional Bangladesh caucus, visiting Bangladesh in presence of the US Ambassador to Bangladesh Ms Marry Ann Peters.
Ms Hasina told the US Congressman that the ultra rightist political parties, Jamat-e-Islami and Islami Okkyo Jote leaders in public speeches in 2000 said Islamic rule like the Taliban rule in Afghanistan would be established in Bangladesh. Two main functionaries the Amir (chief) and secretary- general of the Jamat-e-Islami Matiur Rahman Nizami and M. Mujahid, respectively, were now senior members of the Cabinet.
The Awami League chief made this allegation earlier in her speech at a gathering of party activists in New York, last month, when Ms Zia was attending the SAARC summit in Kathmandu. On her return from Nepal Ms Zia at a press conference wanted to know the names of the Cabinet members.
The "khatib" (head priest ) of the government-run premier mosque in Dhaka in his religious speech on Id praised the Taliban and termed the US government as the most hated terrorists of the present day world.
President of Bangladesh A.Q.M.Badruddoza Chowdhury and number of Cabinet members attended the congregation when the "khatib" made the remarks. The report in local dailies drew flak for the government. Leaders of the Islami Oikkyo Jote (IOJ) in press statement extended full support to the priest and warned against action against him. No action has been taken against yet.
"There are some military sales questions that the Israelis have raised that posed problems for us and we've told them about that," said the official, who spoke on condition of anonymity.
An Islamic court in Nigeria adjourned on Monday the appeal of a mother sentenced to death by stoning for alleged adultery in a case that has sparked international outrage, on Monday. Mother of five, Safiya Hussaini Tungar-Tudu sat quietly breastfeeding her daughter in the court in the northern city of Sokoto as judges set March 18 for the next hearing to decide her fate. This undated photo shows Safiya Hussaini holding her baby in northern Nigeria.


Dr. Nick J. Bruno is the eighth president of the University of Louisiana at Monroe. With 900 employees and a budget of approximately $75 million, ULM is a major education and economic engine for all of north Louisiana. His 30 years of experience in Louisiana higher education is certainly an asset for the university.
Before becoming president of ULM in 2010, Dr. Bruno was Vice President for Business Affairs with the University of Louisiana System. He assisted universities with Capital Outlay and alternatively-financed projects, worked closely with legislative committees as well as the Board of Regents, and revised policies and procedures within the UL System which resulted in streamline processes and greater efficiencies.
From 2002 until 2005, Dr. Bruno served as Vice President for Business Affairs at ULM. While there, he developed and facilitated the financing, design, and construction of the university's total housing inventory of approximately $70 million. Dr. Bruno also eliminated ULM's athletic and auxiliary deficits of over $4 million, replaced the obsolete mainframe computer, established the first campus-wide employee recognition program, developed and updated university policies and procedures, and received only unqualified audits with no findings during his time at ULM.
Beyond Louisiana, Dr. Bruno is known for his consulting work throughout the region and nation in the areas of organizational efficiencies and alternatively-financed facility construction. He has conducted numerous professional development programs for such organizations as the National Association of College and University Business Officers. He has also contributed numerous articles to a variety of higher education publications on topics such as campus services management, quality management, outsourcing campus services, and strategic management.
In addition to his varied professional activities, Dr. Bruno has been involved in a host of service and civic endeavors. He has served as a board member for LaCapitol Federal Credit Union, Chennault Aviation and Military Museum, chair for the Louisiana Association for Personal Financial Achievement, a member of the Executive Committee of the Ouachita Economic Development Corporation, and a member of the Council for the Advancement of Standards for Higher Education. He has also served as a board member for the National Association of College Auxiliary Services, from whom he received a Lifetime Achievement Award. He presently serves on the board of the Monroe Chamber of Commerce, the West Monroe West Ouachita Chamber of Commerce, and St. Francis Medical Center.
In September 2011, the National Association of College Auxiliary Services awarded President Bruno the Presidential Award of Excellence. He was inducted into the Florida Parishes Arena Wall of Fame in June, 2015. He is lauded as a major supporter of the arena's establishment in 2004.
President Bruno earned a bachelor's degree in accounting and an MBA from Southeastern Louisiana University. He earned a Ph.D. in Higher Education Leadership from the University of Mississippi. He served as an adjunct member of Southeastern Louisiana University's College of Business faculty where he taught Strategic Management. In February, 2014, he was the recipient of the Honorary Doctor of Philosophy in Business Administration from the Hanbat National University, Republic of Korea.
Dr. Bruno and his wife Linda have a son, Steven, and two daughters, Victoria and Christina.