Study design: Mortality review was undertaken of patients who su ered traumatic spinal cord injury (SCI) between 1955 and 1994 inclusive. Objectives: The study objective was to provide evidence of reasons for the observed reduction in long-term life expectancy for the SCI population. Setting: Patients were those who had most, if not all, of their inpatient and outpatient care at Royal North Shore Hospital, Spinal Injuries Unit, Sydney, New South Wales, Australia. Methods: Data on causes of death for 195 patients ®tting the inclusion criteria were analysed by actuarial methods using ICD9CM classi®cations. Results: The incidence of death in the spinal cord injured, from septicaemia, pneumonia and in¯uenza, diseases of the urinary uystem and suicide, are signi®cantly higher than in the general population. The ®ndings con®rm variations in potentially treatable causes of death depending on neurological impairment, attained age and duration since injury. Unlike septicaemia and pneumonia, which have shown a signi®cant reduction since 1980, the death rate for suicide alone has risen. Conclusion: This analysis identi®ed complications which a ect mortality and morbidity in patients su ering from the e ects of SCI. Spinal Cord (2000) 38, 604 ± 610

Male infertility is a well recognised problem following spinal cord injury. The techniques of vibration induced ejaculation and transrectal electroejaculation have significantly increased the likelihood of sperm retrieval in spinal cord injured males; however, the reproductive capacity remains markedly reduced due to poor semen quality. The Spinal Injuries Unit at Royal North Shore Hospital has developed a programme to achieve seminal emission and enhance fertility. This study analysed the results of the first sample obtained at stimulation in 70 spinal cord injured males with respect to procedure performed, neurological level, completeness of lesion, bladder management, infection, age and duration since injury. Our study demonstrated that bladder management and neurological level were significant factors affecting the presence of motile sperm. Individuals managing their neuropathic bladder by catheter (intermittent self-catheterisation, indwelling urethral or suprapubic catheter) had significantly enhanced semen quality compared to those voiding by reflex or straining. Differences were also noted within the catheter group itself with intermittent self-catheterisation achieving a higher percentage of motile sperm present.

Objectives: To review the outcomes of management of male infertility following spinal cord injury in a specialised fertility clinic. Study Design: Retrospective review of medical records. Setting: The Fertility Clinic of a 45-bed spinal cord injury service in New South Wales, Australia. Methods: The medical and fertility clinic records of 113 males who attended the clinic between 1987 and 1997 were reviewed. Results: The rates of semen retrieval using vibroejaculation and electroejaculation were 67% and 97% respectively. Thirty-one individuals (37%) and their partners sought assistance with the primary aim of achieving a pregnancy. Intravaginal insemination (IVI) undertaken at home following vibroejaculation resulted in a pregnancy rate per cycle of 22%. Electroejaculation and IVI proved less successful with a pregnancy rate per cycle of only 5%, although with intrauterine insemination (IUI) this rate improved to 30%. Micromanipulation in vitro fertilisation (IVF) procedures, primarily intracytoplasmic sperm injection, were used in 18 couples resulting in a pregnancy rate per cycle of 19%. In the 31 couples there have been a total of 17 pregnancies in 97 cycle attempts for an overall pregnancy rate per cycle of 18% and a cumulative pregnancy rate per couple of 55%. Twelve of the pregnancies have resulted in 14 live births (including two sets of twins), there were three pregnancies ongoing at the date of review and there have been two spontaneous abortions. Conclusion: The bene®ts of a specialised fertility clinic o ering a comprehensive, clientfocused approach with education, fertility assessment and a range of semen retrieval and assisted reproduction options, are highlighted.

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