A comprehensive approach to the management of male infertility following spinal cord injury

Rutkowski, SB; Geraghty, Timothy; Hagen, DL; Bowers, DM; Craven, Mary L.; Middleton, JW

doi:10.1038/sj.sc.3100866

Cited by 39 publications

(27 citation statements)

References 42 publications

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“…This is comparable to previous results of IUI in SCI men 4,6,7,9 and in the low end of results reported from IVF/ICSI that have shown pregnancy rates per couple between 38 and 100%. [3][4][5][6][7][10][11][12] Also, the results are similar to the findings of a smaller study recently published by Kathiresan et al, 13 where PVS followed by intravaginal insemination was undertaken in 45 selected couples. Seventeen of these couples (38% pregnancy rate) achieved 20 pregnancies resulting in 18 live births.…”

Section: Resultssupporting

confidence: 89%

“…Since that initial report, only a limited number of pregnancies have been reported from PVS procedures combined with self-insemination at home. [3][4][5][6][7] Most studies reported that multiple ovulation cycles were used to achieve the home pregnancies and the overall pregnancy rate per couple is ranging from 25 to 61%. [3][4][5][6][7] The purpose of this study is to present the last 20 years' experience from penile PVS and vaginal self-insemination at home in SCI men and their partners.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Resultssupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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

et al. 2011

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“…34 Recent encouraging results of the PVS method 35,38 ± 40 lead us to use this method parallel to the EEJ method. At present we prefer to use the PVS as ®rst line choice treatment in SCIP with a lesion above T10, 12 and to use EEJ in cases of failure.…”

Section: Discussionmentioning

confidence: 99%

Treatment of male infertility due to spinal cord injury using rectal probe electroejaculation: the Israeli experience

et al. 2001

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Study design: Male infertility caused by anejaculation is common among patients with spinal cord injury (SCIP). The fertility options for SCIP have improved impressively over the past 10 years. We present the Israeli experience in the treatment of infertility in a large series of SCIP. The issues which are addressed include the treatment of ejaculatory dysfunction, seminal quality and fertility management in SCIP. Setting: Sexual rehabilitation clinic, Neuro-Rehabilitation department, Sheba Medical Center, Israel. Methods: Between June 1992 and May 1998, a total of 84 consecutive SCIP were treated in our clinic with electro-ejaculation (EEJ), representing a sample of the SCIP population, composed mostly of young men traumatically injured. The patients have sustained dierent levels and completeness of spinal injury. Among the patients 33 were interested in achieving pregnancy (39.3%), while the rest were interested in determining fertility potential for family. With EEJ, a low-current stimulation of the ejaculatory organs via a rectal probe is done. The collected semen is used for fertility determination or for fertilization. Results: Eighty-four patients were treated by EEJ. Mean age was 31.3 and mean age at injury was 21.7. There were 29 cervical, 50 thoracic and ®ve lumbar lesions. Sixty-three had complete injury (ASIA A) and 21 incomplete (ASIA B -15, ASIC C -5, ASIA D -1). Fifty-nine had upper motor neuron lesions, and 25 had lower motor neuron. A total of 355 stimulations were performed. Ejaculate was obtained in all patients in 350 stimulations (98.6%), and sperm was present in 74 patients (88.1%) in 296 of the stimulations (83.4%). Fairly good numbers of spermatozoa were obtained, whereas sperm motility and morphology of spermatozoa were low in most cases. A signi®cant dierence in sperm count, motility and morphology was noted between antegrade and retrograde samples. No signi®cant improvement in sperm quality after four repeated consecutive stimulations was noted in 38 SCIP. Side eects were minor and encountered in 16 patients (19.1%). Out of 33 couples who wished to achieve pregnancy, 26 reached the stage of insemination. Four pregnancies were achieved after 33 cycles of InUterine-Insemination (pregnancy rate 28.6% per couple), and 15 after 68 cycles of In-VitroFertilization (micromanipulation) (pregnancy rate of 68.75% per couple). In all, of 101 conception attempts 23 were successful, resulting in pregnancies in 18 couples, and accounting for an overall pregnancy rate of 70% per couple. Conclusion: The high percentage of pregnancies imply that, despite the typically poor sperm motility noted in EEJ, rectal probe EEJ combined with assisted reproductive techniques, and performed by a team approach, is an ecient and safe technique for treating infertility among SCIP.

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“…[49][50][51][52][53] Although natural sources of stimulation -whether masturbation, intercourse, or oral sex -have been associated with relatively poor success rates in the literature, they should be tried before assistive devices so that persons with SCI may maintain their sexual spontaneity. A recent meta-analysis indicates that 12% of men with SCI achieved ejaculation 54 through masturbation, but early literature indicates more variable results ranging from 5% to 32% 55,56 depending on the lesion type affecting the sacral segments (upper motor neuron [UMN] vs LMN) and completeness of lesion.…”

Section: More Advanced Techniques To Attain Orgasm and Ejaculationmentioning

confidence: 99%

Improving Sexual Satisfaction in Persons with Spinal Cord Injuries: Collective Wisdom

Alexander

Courtois

Elliott

et al. 2017

Topics in Spinal Cord Injury Rehabilitation

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Sexuality is an important part of life, and it is necessary for clinicians to have a specific format in which to address sexual issues with their patients. A systematic approach to working with patients with spinal cord injury (SCI) to improve their sexual functioning and response is presented. Nonjudgmental communication about sexual concerns is followed by a detailed pre-and postinjury medical, psychosocial, and sexual history. If preexisting sexual issues are present, it is recommended that the patient be referred for assessment and treatment of these separate from the patient's SCI-related concerns. Physical examination, with special attention to issues that could impact the patient's sexuality, is followed by a detailed neurologic assessment with specific attention to the T11-L2 and S3-5 spinal segments. Education of the patient with regard to his or her sexual potential and the need to be flexible in his or her sexual repertoire is followed by self-exploration and practice. Routine follow-up is suggested after patient's initial sexual exploration. Treatment of confounding and iatrogenic factors related to SCI is followed by more sexual experience. Afterwards the clinician is encouraged to use simple techniques to treat sexual issues and follow-up with the patient to assess the outcome. A structured program utilizing vibratory stimulation with or without midodrine is described as a way to achieve ejaculation and potentially orgasm, and techniques for treating severe autonomic dysreflexia are discussed. If these interventions do not alleviate the patient's sexual concerns, the clinician should refer the patient for more specialized consultation.

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A comprehensive approach to the management of male infertility following spinal cord injury

Cited by 39 publications

References 42 publications

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

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

Treatment of male infertility due to spinal cord injury using rectal probe electroejaculation: the Israeli experience

Improving Sexual Satisfaction in Persons with Spinal Cord Injuries: Collective Wisdom

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