Ejaculatory stimulation, quality of semen and reproductive aspects in spinal cord injured men

Abstract

This is a retrospective study of 39 male spinal cord injured patients who, over the last 5 years, have consulted us for ejaculatory dysfunction or infertility. All of these patients underwent at least two distinct sessions during which attempts were made to induce an ejaculation by vibratory stimulation, electric stimulation, or by using subcutaneous physostigmine. A semen analysis was performed each time that an ejaculate was obtained. By one or more of these techniques, 75% of these subjects were able to ejaculate. The level of the neurological lesion had a signi®cant in¯uence on the success rate. Likewise, the mode employed to produce an ejaculation in¯uenced certain characteristics of the sperm collected (mean volume, percentage of motile forms), the best results being obtained by vibratory stimulation. Among the 10 couples who had consulted us for medically assisted reproduction, three pregnancies were obtained, two of which resulted in the birth of healthy children. Although the techniques of stimulation that we use allow ejaculation, the possibilities of reproduction remain limited in particular because of the diculty in obtaining semen of adequate quality. Nevertheless, recent methods of micromanipulation of gametes should considerably improve the prognosis of the seminal insuciencies in men with spinal cord injury.

Impact of Sperm Collection Methods on Sperm Parameters in Spinal Cord Injured Men and Compared to Normal Controls in ICSI Program

“…This in later combined by intracytoplasmic sperm injection (ICSI) procedure [11,12] became the only and best method, which is available for all patients by neurological-psychogenic or physiologic an ejaculation [13,14,16]. It was an evolution in infertility treatment [13,14,20]. In this study, the electro ejaculation followed by ICSI procedure was one of the four methods for infertility treatment of an ejaculatory and impotence man.…”

Blood pressure changes during sexual stimulation, ejaculation and midodrine treatment in men with spinal cord injury

“…Therefore, as others suggested [7,16], midodrine might be a functional treatment for anejaculation in men with SCI because it has a rapid onset of action (within 10-30 min), because it reaches its maximum effect within 1 h, can last 3-4 h, and because it is easy to use and well tolerated by patients. Furthermore, while midodrine targets specific α -adrenergic receptors rather than the overall autonomic system, its limited side-effects might be grounded on neurophysiological substrates that contrast with the massive effects reported with anticholinesterase drugs [12][13][14][15].…”

“…Earlier studies used cholinesterase inhibitors such as intrathecal prostigmine (neostigmine) [12,13] and s.c. injections with physostigmine [14,15], and found them to be effective for triggering ejaculation in these men. However, because these cholinergic drugs have powerful sideeffects, including severe headaches, nausea, vomiting, abdominal cramps, diarrhoea (and even one reported death from cerebral haemorrhage) they were abandoned as a treatment option.…”

Treatment of infertility

“…However, when adding the number of sperm isolated from the urine (retrograde fraction) after both procedures, only a slight advantage in the sperm quality from PVS was seen. Two other recent studies 23,41 demonstrated that the motility rate was signi®cantly better in total ejaculates (antegrade+retrograde ejaculations) from PVS compared to EEJ. Whether the dierence in sperm motility and viability between PVS and EEJ may have any in¯uence on the reproduction capability will have to be evaluated in a randomized prospective study including SCI men and their partners undergoing fertility treatment.…”

“…The number of sperm with low motility exhibited by this patient is in accordance with the literature. According to Le Chapelain et al 23 the mean semen volume procured by PVS is greater than that obtained using EEJ and the percentage of motile sperm was signi®cantly lower in semen procured by EEJ as opposed to that collected by PVS. In the present case we would not try vibratory ejaculation plus vaginal injection of the semen because the success rate of this method is very low and the patient's partner is not so young, demanding a quick solution.…”