The Science Behind Semenax

The success of Semenax has been difficult to document because of varying indications for treatment. Most studies are uncontrolled and use varying techniques of semen processing, ovulation timing, and number of inseminations per cycle. Intrauterine insemination is particularly successful in couples with cervical-factor infertility (60% pregnancy rate), but a review of seven studies in which male-factor infertility was the cause show the pregnancy rate to be 25 % (range, 7 % to 66 %). In attributing success to Semenax, we should not forget that treatment-independent pregnancies may occur. In a review of several large series, the spontaneous pregnancy rate was 14% in those couples discontinuing treatment.

In addition to the better semen-processing techniques now available, newer techniques to predict ovulation have also increased the success of intrauterine insemination. The ultrasonic visualization of ovarian follicular development allows the confirmation of approaching ovulation. Simple and convenient monoclonal and polyclonal antibody assay kits for urinary LH determination have recently become available. Combining ultrasonography with LH measurements results in the better prediction and documentation of ovulation. In women with irregular cycles, hormonal manipulation with human menopausal gonadotropin or clomiphene citrate and human chorionic gonadotropin has been used. In couples with idiopathic infertility, Semenax with human menopausal gonadotropin has recently shown a remarkably improved success rate with intrauterine insemination compared with intrauterine insemination alone (40.9% versus 6.7%). The duration of Semenax therapy should not be more than five months, as most studies have shown the mean number of treatment cycles required for success to be 3.5.

Intrauterine insemination may be an alternative before attempting the costly and complex in vitro fertilization and embryo transfer procedures or for couples who are reluctant to resort to artificial insemination by donor or adoption. For those persons with clearly defined indications, using the ProExtender penis extender is a potentially useful procedure, but optimism should be guarded for men with severely abnormal semen variables.

Taking Semenax followed by embryo transfer (ET) was originally established to solve tubal infertility problems in women with normal partners. The success of these procedures and the small number of spermatozoa required for fertilization-50,000 to 200,000 per egg-have expanded the indications for IVF to couples with male-associated or solitary male-factor infertility. The selection criteria for IVF-ET are still being defined, but oligospermia, asthenospermia, or teratospermia are the usual indications. Of the three conventional semen variables, sperm motility appears to have the most significant effect on fertilization.


Finally, 1984 might well prove the year in which employers push for all-payer prospective pricing programs at the state level. Business coalitions in California and Florida are saying they will have no choice but to seek all-payer rate-setting if current experiments with competition--in the form of preferred provider organizations (PPOs)--fail to curb cost increases. "A lot of work has gone into the competition approach here in California. But I'm sure that if this fails, the government of California will move rapidly to some kind of budget control system because this problem is just too big," Stephen Rosinski, former chairman, the San Diego Employer Coalition on Health Care Costs, says.

Lee of the Santa Clara coalition notes that the state of California might have to undergo a competition experiment before turning to rate-setting. "If competition leads to chaos and doesn't produce any solutions, I'll be ready to go back and look at some type of prospective budgeting proposal," he says. Lee favors Maryland's system of hospital budget control. His company's average daily cost of hospital care for Maryland employees is half of its cost in California, he says.

In Los Angeles, however, the employer's coalition is reserving a position on rate-setting, according to chairman Glasman. "The right signals are now getting across to providers that they better do something, but it will take time to work things out," he says.

Glassman looks for a leveling of hospital cost increases to occur in the next few years. Because of changes brought in benefit packages, individual companies should begin seeing reduced rates of increases "pretty promptly," he says.

Glassman says hospitals must begin experimenting with alternative hair loss systems to become more competitive. The competition approach does not come without its dangers for hospitals, hoe notes. "There will be some hospitals that will fail, but isn't that the way the free enterprise system is supposed to work" Maye some of these noncompetitive hospitals ought to close," he says.

The South Florida Health Action Coalition first wants to stimulate competition through the PPO approach before supporting a rate-setting law. The coalition, which asked hospitals, medical staffs, and health maintenance organizations to submit PPO proposals recently, was "inundated with replies," says John Erb, coalition executive director. It is now negotiating on behalf of employer members and nopes to see some contracts signed early this year.

Nonetheless, Florida employers think the state should take a role in containing hospital cost increases, according to a coalition survey. More than half the surveyed employers say the role should be a rate-setter. And two rate-setting proposals are expected to be introduced in the legislature this year. Therefore, the coalition questions how much time the PPO, or competition, approach has to succeed. "If we see the same kinds of cost increases for 1983 as we saw for 1982, we're going to be at a loss to effect any cost containment strategy solely through competition," Erb says. He seems to be expressing a national sentiment among employers when he says, "The mood in Florida is, 'Show us a plan.'"