Male infertility in spinal cord trauma

Abstract

Every year there are 10 thousand new cases of patients victimized by spinal cord trauma (SCT) in the United States and it is estimated that there are 7 thousand new cases in Brazil. Eighty percent of patients are fertile males. Infertility in this patient group is due to 3 main factors resulting from spinal cord lesions: erectile dysfunction, ejaculatory disorder and low sperm counts. Erectile dysfunction has been successfully treated with oral and injectable medications, use of vacuum devices and penile prosthesis implants. The technological improvement in penile vibratory stimulation devices (PVS) and rectal probe electro-ejaculation (RPE) has made such procedures safer and accessible to patients with ejaculatory dysfunction. Despite the normal number of spermatozoa found in semen of spinal cord-injured patients, their motility is abnormal. This change does not seem to be related to changes in scrotal thermal regulation, frequency of ejaculation or duration of spinal cord damage but to factors related to the seminal plasma. Despite the poor seminal quality, increasingly more men with SCT have become fathers through techniques ranging from simple homologous insemination to sophisticated assisted reproduction techniques such as intracytoplasmic sperm injection (ICSI).

Testicular sperm retrieval and intra cytoplasmic sperm injection provide favorable outcome in spinal cord injury patients, failing conservative reproductive treatment

“…It has been demonstrated that the general rehabilitation process is more effective when attention is given to sexual function and infertility. 3 PVS is used as a first line of treatment, as it is more physiological with better semen quality. 4,5 In most patients with lesions above T10, semen may be produced effectively by PVS.…”

“…Recent studies shows that these changes are due to accessory gland dysfunction and altered semen constituents due to stasis of prostatic fluid, testicular hyperthermia, recurrent urinary tract infections, abnormal testicular histology, hypothalamic-pituitary-testicular axis changes, sperm antibodies, chronic long-term use of various medications and bladder dysfunction. [1][2][3]6,[12][13][14] In addition, the EEJ procedure may further hamper sperm quality by the electroporation injuries. [14][15][16] Other SCI patients may also suffer from either primary testicular failure or obstructive azoospermia.…”

“…1 Most of them suffer from infertility, mainly due to erectile and/or ejaculatory dysfunction. 2,3 Antegrade ejaculation has been reported in 5% of patients with complete upper motor neuron lesions, 18% with complete lower motor neuron lesions and 32% with incomplete upper motor neuron lesions and 70% with incomplete lower motor neuron lesions.…”

A short-term arm-crank exercise program improved testosterone deficiency in adults with chronic spinal cord injury

“…Similarly, a recent review reported it may also contribute to the impairment of semen quality in spinal cord injured men (4).…”

Measurement of Sexual Functioning After Spinal Cord Injury: Preferred Instruments

“…PVS has several advantages over EEJ. Although both methods are safe, reliable, and effective (68)(69)(70), EEJ is more invasive, and the cost of purchasing PVS equipment is approximately 1/20th the cost of purchasing EEJ equipment (ie, approximately $800 vs $16,000; 2008 prices). PVS is preferred more by patients, and the semen quality obtained by PVS is usually of better quality than the semen obtained by EEJ (61,62).…”