Pregnancy outcomes by intravaginal and intrauterine insemination in 82 couples with male factor infertility due to spinal cord injuries

Kathiresan, A.S.Q.; Ibrahim, Emad; Aballa, Teodoro C.; Attia, George R.; Lynne, Charles M.; Brackett, Nancy L.

doi:10.1016/j.fertnstert.2011.05.019

Cited by 37 publications

(39 citation statements)

References 26 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%

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%

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

et al. 2011

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“…5 IVF/ ICSI in couples with an SCI male partner have shown similar pregnancy rates compared with couples with other male factor etiologies. 6 Although the authors acknowledged several study limitations, it still confirms previous reports of successful pregnancies using sperm from men with SCI. It is worth noting that elective sperm cryopreservation is not a medical necessity in this population based on reports showing no decline in semen quality after chronic SCI.…”

supporting

confidence: 80%

“…However, ejaculated sperm with penile vibratory stimulation is reported to achieve a favorable conception rate without the aid of assisted reproductive technology (ART) in the USA. 6 C-TESE/micro-TESE and ART cost less in Japan than in the USA. Still, ART is more accessible in Japan, because Japan has the highest number of ART institutes in the world.…”

Section: Editorial Comment Editorial Comment From Dr Kanto To Testicumentioning

confidence: 99%

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

Kanto¹

2016

Int J of Urology

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80.7% of the patients, the pregnancy rate per couple was 86.5% by IVF/ICSI and the take-home baby rate was 70.2%. The authors reported significantly larger testicular volume in the successful group than in the unsuccessful group. The time from SCI was significantly shorter, and serum luteinizing hormone as well as serum follicle-stimulating hormone were significantly lower in the successful group. Serum folliclestimulating hormone had the strongest association with successful sperm collection by TESE in SCI patients.As reported in the literature, after SCI men suffer from erectile dysfunction, ejaculatory dysfunction and abnormal semen quality. PVS is considered the first line of choice for managing anejaculation in this population. It has an 86% success rate in patients with a neurological level of injury at or rostral to T10.2 If PVS fails, electroejaculation is the next method of choice, if available, with almost 100% success rate.2 Autonomic dysreflexia can be managed by premedication (e.g. nifedipine) and monitoring vital signs.3 Surgical sperm retrieval is the last resort if PVS and electroejaculation fail to induce ejaculation. Although men with SCI have a normal sperm count, they present with low sperm motility and viability.4 Pregnancy rates range from 24% to 70% using intravaginal (home) insemination or intrauterine insemination, as reported in the literature.5 IVF/ ICSI in couples with an SCI male partner have shown similar pregnancy rates compared with couples with other male factor etiologies. 6 Although the authors acknowledged several study limitations, it still confirms previous reports of successful pregnancies using sperm from men with SCI. It is worth noting that elective sperm cryopreservation is not a medical necessity in this population based on reports showing no decline in semen quality after chronic SCI.

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“…The methods of PVS and EEJ have been the primary methods of sperm retrieval in couples with SCI male partners undergoing assisted conception procedures. 10,11 Previous studies have shown that sperm motility is better when collected by PVS versus EEJ in men with SCI. 12,13 While the exact mechanism is unknown, it has been speculated that ejaculation by PVS is more physiologically normal than ejaculation by EEJ.…”

Section: Discussionmentioning

confidence: 99%

“…When necessary, retrograde fractions can be a useful source of sperm for insemination procedures. 10,11 Our study is limited by a possible selection bias. The extent to which our study is representative of the general population of men with SCI is uncertain.…”

Section: Discussionmentioning

confidence: 99%

Semen quality in ejaculates produced by masturbation in men with spinal cord injury

et al. 2012

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Pregnancy outcomes by intravaginal and intrauterine insemination in 82 couples with male factor infertility due to spinal cord injuries

Cited by 37 publications

References 26 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

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

Semen quality in ejaculates produced by masturbation in men with spinal cord injury

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