Male fertility following spinal cord injury: an update

Abstract

SUMMARYSpinal cord injury (SCI) occurs most often in young men at the peak of their reproductive health. The majority of men with SCI cannot father children naturally. Three major complications contribute to infertility in men with SCI: erectile dysfunction, ejaculatory dysfunction, and abnormal semen quality. Erectile dysfunction can be managed by regimens available to the general population, including oral administration of phosphodiesterase-5 (PDE-5) inhibitors, intracavernosal injections, vacuum devices, and penile prostheses. Semen may be obtained from anejaculatory men with SCI via the medically assisted ejaculation methods of penile vibratory stimulation (PVS) or electroejaculation (EEJ). Sperm retrieval is also possible via prostate massage or surgical sperm retrieval. Most men with SCI have abnormal semen quality characterized by normal sperm concentrations but abnormally low sperm motility and viability. Accessory gland dysfunction has been proposed as the cause of these abnormalities. Leukocytospermia is evident in most SCI patients. Additionally, elevated concentrations of pro-inflammatory cytokines and elevated concentrations of inflammasome components are found in their semen. Neutralization of these constituents has resulted in improved sperm motility. There is a recent and alarming trend in the management of infertility in couples with SCI male partners. Although many men with SCI have sufficient motile sperm in their ejaculates for attempting intrauterine insemination (IUI) or even intravaginal insemination, surgical sperm retrieval is often introduced as the first and only sperm retrieval method for these couples. Surgical sperm retrieval commits the couple to the most advanced, expensive, and invasive method of assisted conception: in vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI). Couples should be informed of all options, including semen retrieval by PVS or EEJ. Intravaginal insemination or IUI should be considered when indicated.

Evaluation of sexual and fertility dysfunction in spinal cord-injured men in Jamaica

“…9 This was borne out in our study, where over 70% of patients were unable to ejaculate. Successful methods to produce antegrade ejaculation include penile vibratory stimulation and electro-ejaculation.…”

“…[6][7][8] Advances in medicine have increased the options for treatment of sexual dysfunction and infertility in men with SCI. 9 Oral phosphodiesterase inhibitors, such as sildenafil are highly efficacious in the treatment of ED in SCI. 10 Interventions to induce ejaculation have a success rate of 95% and pooled analyses reveal a pregnancy rate after advanced fertility treatments of 51%.…”

Reproductive Health of Men with Spinal Cord Injury

“…There are 3 common sequelae of SCI that impact fertility: erectile dysfunction, ejaculatory dysfunction, and abnormal semen quality. 9 Techniques to help achieve improved erections and ejaculation, coupled with advances in assisted reproductive technologies, have made fathering biologic children a reality for men living with SCI.…”

Editorial Comment from Dr Kanto to Testicular sperm extraction for patients with spinal cord injury‐related anejaculation: A single‐center experience

“…Chronic urinary tract infection could be the most plausible cause, because infiltrating leukocytes secrete cytokines that could damage sperm. 1 In this respect, testicular sperm may be the best candidate to inject into oocytes, because testicular sperm are protected by the testis-blood barrier. Iwahata et al have shown that the period of the injury is one of the prognostic factors for conventional testicular sperm extraction (C-TESE) or microdissection testicular sperm extraction (micro-TESE).…”