Electroejaculation Versus Vibratory Stimulation in Spinal Cord Injured Men: Sperm Quality and Patient Preference

Ohl, Dana A.; Sønksen, Jens; Menge, Alan C.; McCabe, Marcianna; Keller, Laura

doi:10.1016/s0022-5347(01)64698-6

Cited by 114 publications

(90 citation statements)

References 9 publications

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Section: Discussionmentioning

confidence: 99%

“…4 ± 6,20 Compared to the alternative treatment of electroejaculation, PVS is less invasive, is preferred more by patients, 21 and results in better semen quality. 21,22 PVS, however, is not successful in all patients, and there are currently no established guidelines for selecting patients for this method. While previous studies have shown that higher success rates of ejaculation are obtained with high compared to low levels of injury, 4,23 and high compared to low amplitude vibration, 4,13 these parameters are not completely predictive of ejaculation.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Reflexes and somatic responses as predictors of ejaculation by penile vibratory stimulation in men with spinal cord injury

et al. 2001

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Study design: Retrospective chart review. Objective: To identify factors in addition to level of injury (LOI) that may predict ejaculation by penile vibratory stimulation (PVS) in spinal cord injured males. Setting: Major urban medical school and teaching hospital. Materials and methods: Presence of a bulbocavernosus response (BCR) and a hip¯exor response (HR) before PVS (n=123 patients), and somatic responses during PVS (n=204 trials performed on a subset of 44 patients) were evaluated for their frequency of occurrence on trials with and without ejaculation. Results: Overall ejaculation success rates for cervical, T1 ± T6, and T7 ± T12 LOI were 71%, 73%, and 35%, respectively. Eighty per cent of patients who were positive for both BCR and HR ejaculated with PVS, while only 8% of patients who were negative for both BCR and HR ejaculated with PVS. For cervical injuries, BCR and HR were no more predictive of ejaculation by PVS than LOI alone. T1 ± T6 patients were more likely to ejaculate when at least one re¯ex was present. T7 ± T12 patients with no BCR were unlikely to ejaculate by PVS. Except for abdominal contractions, somatic responses were not present in the majority of PVS trials. When they were present, however, they occurred in a high percentage of ejaculation trials: withdrawal response (hip¯exion, knee¯exion and thigh adduction) (90%), piloerection (84%), extremity spasms (83%), thigh abduction (80%), and thigh adduction (72%). Conclusion: We recommend that patients with cervical injuries initially undergo PVS. Patients with T1 ± T6 LOI with at least one re¯ex present, and patients with T7 ± T12 LOI with both re¯exes, or only BCR present, may undergo PVS. Certain somatic/autonomic responses, when seen, may help in deciding whether to continue with a given trial, or give a repeat trial, of PVS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reflexes and somatic responses as predictors of ejaculation by penile vibratory stimulation in men with spinal cord injury

et al. 2001

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“…[4][5][6][7][8][9] In our previous study, by using EEJ combined with assisted reproductive technique (ART), we showed high percentage of pregnancies despite the typically poor sperm motility. 10 In cases where azoospermia was evident during initial evaluation, the only option to conceive was to perform testicular biopsy for sperm retrieval and IVF.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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Study design: Retrospective cohort analysis. Objectives: The objective of this study was to determine the in vitro fertilization (IVF) outcome after testicular sperm extraction (TESE) in a group of spinal cord injury (SCI) male patients not compatible with conservative fertility treatment. Setting: University-affiliated medical center. Methods: Thirty two SCI patients (C2 to L2) were referred to IVF after repeated trials of electroejaculation (EEJ) or penile vibratory stimulation (PVS), and full andrological evaluation. Testicular sperm aspiration (TESA) was the method of choice for sperm extraction. Open TESE was performed only after a negative TESA attempt. Clinical pregnancy and live birth rates were determined. Results: A total of 106 testicular procedures were performed. Sperm was found in 95 cycles (89.6%). The average metaphase II (MII) oocyte number was 11.0 ± 4.2, an average of 5.1 ± 2.3 oocytes became normally fertilized after Intra Cytoplasmic Sperm Injection (ICSI) (fertilization rate 57.1%). On average, 2.7 ± 1.2 embryos were replaced. The clinical pregnancy rate was 32/106 (30.2%) per cycle and 19/32 (59.3%) per couple. Live birth rate was 62.5% (20/32). Conclusions: TESA/E and IVF can provide excellent prognosis for SCI patients that cannot be treated by EEJ or PVS.

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“…Both of these techniques are far more invasive than PVS and generally result in fewer motile sperm. 15 In EEJ, electricity is delivered through a rectal probe to induce ejaculation, which always requires administration by a doctor. Furthermore, SCI men with incomplete lesions and/or preserved pelvic sensation may require general anesthesia.…”

Section: Resultsmentioning

confidence: 99%

“…In contrast to PVS, in which the vast majority of patients have mainly antegrade ejaculation, EEJ often results in some degree of retrograde ejaculation, which must then be collected from the bladder by cathetrization after EEJ. 15 Surgical sperm retrieval, which may involve testicular biopsies and/ or needle aspiration of sperm from the testis or epididymis 16 are invasive procedures that may result in a variety of adverse events including bleeding, infection and prolonged testicular pain. Furthermore, the numbers of sperm obtained from surgical sperm retrieval procedures are usually so low that it commits the couple to higher levels of ART such as IVF/ICSI.…”

Section: Resultsmentioning

confidence: 99%

Vibratory ejaculation in 140 spinal cord injured men and home insemination of their partners

et al. 2011

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Study design: Retrospective cohort study. Objectives: Anejaculation is commonly found in spinal cord injured (SCI) men. Clinical treatments and assisted reproductive techniques allow SCI men to father children but few home pregnancies have been reported. The objective of this paper is to evaluate the results from the last 20 years' of treatment with penile vibratory stimulation (PVS) and vaginal self-insemination at home in SCI men and their partners. Setting: The data originate from two European centers and one American center. Methods: A total of 140 SCI men with anejaculation and their healthy partners were available for this analysis. Men who obtained antegrade ejaculation by PVS and had motile sperm in the ejaculate were offered the possibility of PVS combined with vaginal selfinsemination at home. Couples were instructed to perform PVS and to instill the ejaculate intravaginally. Outcome measures were pregnancy rate per couple, number of live births, total motile sperm count and time to pregnancies. Results: Median total motile sperm count was 29 million (range, 1-92 million). In all, 60 of the 140 couples (43% pregnancy rate) achieved 82 pregnancies. Seventy-two of the pregnancies resulted in live births with the delivery of 73 healthy babies. Median time to first pregnancy was 22.8 months (6.0-98.4). No complications were reported. Conclusion: PVS combined with vaginal self-insemination may be performed as a viable, inexpensive option for assisted conception in couples in whom the SCI male partner has an adequate total motile sperm count and the female partner is healthy.

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Electroejaculation Versus Vibratory Stimulation in Spinal Cord Injured Men: Sperm Quality and Patient Preference

Abstract: There was a slight advantage in sperm quality and a high patient preference in favor of penile vibratory stimulation. Penile vibratory stimulation should be attempted first to induce ejaculation in spinal cord injured men, with electroejaculation reserved for failures.

Cited by 114 publications

References 9 publications

Reflexes and somatic responses as predictors of ejaculation by penile vibratory stimulation in men with spinal cord injury

Reflexes and somatic responses as predictors of ejaculation by penile vibratory stimulation in men with spinal cord injury

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

Vibratory ejaculation in 140 spinal cord injured men and home insemination of their partners

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