Cross‐sectional study of the sperm quality in semen samples from spinal cord injured men after long‐term cryopreservation

Abstract

SUMMARYThe deterioration of semen quality occurs very early after spinal cord injury (SCI). Thus, routine cryopreservation of semen early after injury has been recommended. However, there is currently a lack of data concerning the effects of long-term cryopreservation on the quality of spermatozoa from SCI men. We have therefore investigated the quality of spermatozoa from SCI men before and after long-term cryopreservation. The semen cryobank of a SCI rehabilitation center was screened for samples with a storage duration of more than 3 years, to carry out a cross-sectional study regarding the sperm quality of semen samples from SCI men. Semen quality analysis was carried out according to the WHO-Guidelines. The quality of 28 semen samples from 16 SCI men was investigated prior to and a median 11 years (95% CI 7-13 years) after cryopreservation. Prior to cryopreservation, ejaculate volume (median = 1.7 mL, 95% CI 1-3 mL) and sperm concentration (median = 106 9 10 6 /mL, 95% CI 82-132 9 10 6 /mL) were within normal limits, but total sperm motility (median = 19%, 95% CI 13-22%) and viability (median = 27%, 95% CI 19-45%) were reduced. Cryopreservation resulted in a significant (p < 0.0001) decrease in total sperm motility (median = 2.5%, 95% CI 0-4%) and viability (median = 7%, 95% CI 6-13%). There were no significant (p = 0.75) differences between the semen parameters of samples collected early (up to 3 weeks) after SCI and those collected later. Complete SCI had a significantly (p < 0.0001) negative effect on the sperm viability of the fresh semen samples, and tetraplegia had a significantly (p < 0.035) negative effect on both pre-cryopreservation sperm viability and post-cryopreservation motility. The assisted ejaculation technique had no significant (p > 0.053) effect on semen quality. Long-term cryopreservation of semen from SCI men results in essentially immotile sperm with minimal viability. Thus, routine long-term cryobanking of semen harvested early after SCI cannot be recommended.

Fertility in men with spinal cord injury

“…These results have been confirmed recently following TESE and ICSI in SCI patients after repeated trials of EEJ or PVS with the clinical pregnancy rate of 30.2% per cycle and 59.3% per couple and live birth rate of 62.5% [12]. Although some studies [42,43,53] don't recommend freezing sperm in SCI patients, the results of ICSI outcomes using frozen/thawed sperm obtained after PVS or surgical sperm retrieval may be encouraging (pregnancy rates per couple 50% versus 75%) and cryopreservation could be performed in such patients as a preventive measure [11]. (Table I)…”

“…Since the semen quality remains stable without clinically significant changes during the chronic phase of SCI after the injury, this information may be useful for family planning [41]. Therefore routine long-term cryobanking of semen harvested early after SCI cannot be recommended, because long-term cryopreservation of semen results in essentially immotile sperm with minimal viability [42]. Since semen cryopreservation may be detrimental on mitochondrial activity and DNA fragmentation in addition to conventional semen variables, therefore other studies to preserve fertility from patients with SCI and improve their seminal quality should be performed [43].…”

Identification of protein changes in human spermatozoa throughout the cryopreservation process

“…The advent of semen cryopreservation has provided patients the opportunity to father their own children through the use of assisted reproductive technology (ART) such as in vitro fertilization IVF or intracytoplasmic sperm injection (ICSI) (Williams, ; Di Santo et al ., ; Tournaye et al ., ; Brezina et al ., ; Daudin et al ., ). Semen is routinely cryopreserved prior to corrective surgery, cytotoxic chemotherapy, or radiotherapy all of which could lead to testicular failure or ejaculatory dysfunction (Krebs et al ., ; Tomlinson et al ., ). Although semen cryopreservation has been successfully utilized in ART technology for decades, the technique is not perfect as an inevitable consequence of cryopreservation is cryoinjury (Ribas‐Maynou et al ., ; Braga et al ., ).…”

Improvement of Sexual and Reproductive Function in Men with Spinal Cord Lesion

“…Furthermore, since pregnancy rates per fresh testicular sperm-ICSI are significantly higher than those per frozen-thawed sperm-ICSI (64% vs. 25%), this approach represents the most promising option for couples with SCL desiring pregnancy ( 56 ). However, despite recommendations against freezing sperm in SCL patients reported by some studies ( 45 , 46 , 56 ), it seems that cryopreservation may be advisable owing to the reasonable results (pregnancy rates per couple 50% vs . 75%) achieved by use of frozen/thawed sperm obtained after PVS or surgical sperm retrieval combined with ICSI ( 11 ).…”