Testicular sperm extraction for patients with spinal cord injury‐related anejaculation: A single‐center experience

Abstract

Abbreviations & Acronyms ART = assisted reproductive technologies C-TESE = conventional testicular sperm extraction EEJ = electroejaculation EjD = ejaculatory dysfunction FSH = follicle-stimulating hormone ICSI = intracytoplasmic sperm injection IUI = intrauterine insemination LH = luteinizing hormone micro-TESE = microdissection testicular sperm extraction PVS = penile vibratory stimulation SCI = spinal cord injury SRR = sperm retrieval rate TESE = testicular sperm extraction Objectives: To present a single-center experience with testicular sperm extraction and intracytoplasmic sperm injection for fathering biological children in patients with ejaculatory dysfunction as a result of spinal cord injury. Methods: Testicular sperm extraction was carried out in 52 male patients with ejaculatory dysfunction as a result of spinal cord injury. We investigated sperm retrieval rates and pregnancy rates from medical records. Data on age, testicular volume, hormonal status (luteinizing hormone, follicle stimulating hormone and testosterone), and time since spinal cord injury were obtained and analyzed to detect potential associations with the presence of spermatogenesis. Results: Testicular sperm retrieval was achieved in 42 of 52 patients (80.7%). Intracytoplasmic sperm injection was carried out for 37 patients, and pregnancy was achieved in 32 (86.5%). The take-home baby rate was 70.2%. In the group with successful sperm extraction, testicular volume was significantly greater, time from spinal cord injury to extraction was significantly shorter, and serum luteinizing hormone and folliclestimulating hormone levels were significantly lower. Serum follicle-stimulating hormone levels had the strongest association with feasibility of sperm retrieval by testicular sperm extraction. Furthermore, the sperm retrieval rates of patients injured within the preceding 12 years were significantly better than those injured longer before treatment (P = 0.045). Conclusions: Testicular sperm extraction and intracytoplasmic sperm injection seem to provide favorable results for patients with ejaculatory dysfunction as a result of spinal cord injury. However, early testicular sperm extraction is recommended, because sperm retrieval becomes more difficult with time from spinal cord injury.

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

“…Early reports in 1987 revealed a pregnancy rate of 0% in partners of men with SCI. 25 This has increased to as high as a pregnancy rate of~87% and live birth rate of 70% in more recent reports. 26 Assisted reproductive techniques with good outcomes are available in Jamaica at the Hugh Wynter Fertility Management Unit, which was established in 1979.…”

A Japanese man with spina bifida who successfully fathered a child following fertility treatment

“…For testicular dysfunction, there are few reported cases on spina bifida, although studies on patients with spinal cord injury exist. In these patients, when the period post‐injury exceeds 12 years, it becomes difficult to collect sperm . Moreover, when these patients experience repeated UTIs such as epididymitis, disorders in the passage of sperm could occur.…”

Over‐expression of hsa_circ_0000116 in patients with non‐obstructive azoospermia and its predictive value in testicular sperm retrieval

“…Thirdly, the correlations between hsa_circ_0000116 expression and the clinical‐pathological parameters such as age, serum hormone levels (FSH, LH, PRL, E2 and T), testicular volume, and Johnsen score were evaluated using Spearman's correlation test. Finally, as reported in literature, 29 univariate and multivariate logistic regression analyses were performed to identify the influencing factors of sperm retrieval in micro‐TESE. All statistical tests were two‐sided and were considered statistically significant at P < .05.…”