Male infertility and erectile dysfunction in spinal cord injury: A review

Monga, Manoj; Bernie, Jonathan E.; Rajasekaran, Mahadevan

doi:10.1016/s0003-9993(99)90039-4

Cited by 76 publications

(56 citation statements)

References 74 publications

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“…60 Initially it was used only in SCL individuals with intact re¯exogenic erectile response, but subsequently it was also found eective in SCL men with no residual erectile function. 31 In a study where the neurological conditions permitting therapeutic success for sildena®l was evaluated, it was concluded that the ecacy depends on sparing of either sacral (S 2 ± 4 ) or thoracolumbar (T 10 -L 2 ) spinal segments. 61 This suggests that the absence of both psychogenic (non-somesthetic supraspinally elicited) and re¯exogenic (somesthetic spinally elicited) erections seemed to exclude a successful treatment.…”

Section: Pharmacological Managementmentioning

confidence: 99%

Sexual function in spinal cord lesioned men

2001

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Study design: Review of literature. Objective: To review the physical aspects related to penile erection, ejaculatory dysfunction, semen characteristics, and techniques for enhancement of fertility in spinal cord lesioned (SCL) men. Setting: Worldwide: individuals with traumatic as well as non-traumatic SCL. Results: Recommendations for management of erectile dysfunction in SCL men: If it is possible to obtain a satisfactory erection but of insucient duration, then try to use a venous constrictor band to ®nd out if this is sucient to maintain the erection. Otherwise we recommend Sildena®l. If Sildena®l is not satisfactory then use intracavernous injection with prostaglandin E 1 (some SCL men may prefer cutaneous or intraurethral application). We discourage the implantation of penile prosthesis for the sole purpose of erection. Recommendations for management of ejaculatory dysfunction in SCL men: Penile vibratory stimulation (PVS) to induce ejaculation is recommended as ®rst treatment choice. If PVS fails, SCL men should be referred for electroejaculation (EEJ). Semen characteristics: Impaired semen pro®les with low motility rates are seen in the majority of SCL men. Recently reported data gives evidence of a decline in spermatogenesis and motility of ejaculated spermatozoa shortly after (few weeks) an acute SCL. It is suggested that some factors in the seminal plasma and/or disordered storage of spermatozoa in the seminal vesicles are mainly responsible for the impaired semen pro®les in men with chronic SCL. Fertility: Home insemination with semen obtained by PVS and introduced intravaginally in order to achieve successful pregnancies may be an option for some SCL men and their partners. The majority of SCL men will further enhance their fertility potential when using either PVS or EEJ combined with assisted reproduction techniques such as intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection. Spinal Cord (2001) 39, 455 ± 470

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Section: Pharmacological Managementmentioning

confidence: 99%

Sexual function in spinal cord lesioned men

2001

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“…2 It has been found that the rehabilitation process is more ecient when attention is given to the sexual as well as the physical aspects of the disability. 3 Most SCIP suer from infertility, mainly due to erectile and/or ejaculatory dysfunc-tion. Approximately 54% to 82% of these individuals can maintain full or partial erection, but only 3% to 15% can demonstrate ejaculatory capability.…”

Section: Introductionmentioning

confidence: 99%

“…Approximately 54% to 82% of these individuals can maintain full or partial erection, but only 3% to 15% can demonstrate ejaculatory capability. 3,4 Antegrade ejaculation has been reported in 5% of patients with complete upper motor neuron lesions (UMN), 18% with complete lower motor neuron lesions (LMN), 32% with incomplete UMN and 70% with incomplete LMN. 2,3 Those ejaculations usually present low sperm quality 5,6 and signs of infection.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 Antegrade ejaculation has been reported in 5% of patients with complete upper motor neuron lesions (UMN), 18% with complete lower motor neuron lesions (LMN), 32% with incomplete UMN and 70% with incomplete LMN. 2,3 Those ejaculations usually present low sperm quality 5,6 and signs of infection. 7 Retrograde ejaculation is common, due to sympathetic denervation of the bladder neck.…”

Section: Introductionmentioning

confidence: 99%

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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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“…이러한 환자에게 충분한 양의 정액 을 채취하기 위하여 발기부전 치료제를 처방하였다. 발기부전 치료제가 선택적 type 5-phosphodiesterase (PDE) 억제제이기 때문에 발기부전 치료제의 광범위한 사용이 문제가 될 수 있다 [3]. 예전에, 비록 비선택 적 억제제이긴 하나 pentoxifylline 같은 다른 PDE 억제제들이 정자 기능 에 영향을 끼친다는 보고들이 있다 [4].…”

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The effect of udenafil (zydena) on the fertilization and early embryo development in mice

천근수

심재철

양회생

2011

Korean J Obstet Gynecol

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ObjectiveTo determine the effect of udenafi l, a cyclic monophosphate-specifi c type 5 phosphodiesterase inhibitor, on fertilization and early embryo cleavage of mice. MethodsThis mammal study included randomly assigned male and female mice. The females were sacrifi ced after mating to evaluate their oocytes and embryos in four different time intervals following the treatment. Female mice were injected intraperitoneally with 5 IU of gonadotropin and human chorionic gonadotropin to stimulate follicular growth and induce ovulation. They were separately caged with males that had been gavaged with udenafi l (0.06 mg/0.05 mL) and allowed to mate. After 24, 48, 72, and 96 hours of time intervals, females were killed, their oviducts were dissected out, and retrieved embryos were assessed for blastomere number and quality. Fertilization rates and numbers of embryos were evaluated after treatment. ResultsFertilization rates were reduced in females that were mated with udenafi l gavaged males. Over days 2-4, the numbers of embryo that of the treated group were signifi cantly fewer than in the control group. There was also a tendency of impaired cleavage rates with those embryos. ConclusionThe impairments of fertility caused by udenafi l have important implications for infertility centers and couples who are using this drug precoitally while attempting to conceive.

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Male infertility and erectile dysfunction in spinal cord injury: A review

Cited by 76 publications

References 74 publications

Sexual function in spinal cord lesioned men

Sexual function in spinal cord lesioned men

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

The effect of udenafil (zydena) on the fertilization and early embryo development in mice

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