Testicular sperm retrieval and intra cytoplasmic sperm injection provide favorable outcome in spinal cord injury patients, failing conservative reproductive treatment

Abstract

Study design: Retrospective cohort analysis. Objectives: The objective of this study was to determine the in vitro fertilization (IVF) outcome after testicular sperm extraction (TESE) in a group of spinal cord injury (SCI) male patients not compatible with conservative fertility treatment. Setting: University-affiliated medical center. Methods: Thirty two SCI patients (C2 to L2) were referred to IVF after repeated trials of electroejaculation (EEJ) or penile vibratory stimulation (PVS), and full andrological evaluation. Testicular sperm aspiration (TESA) was the method of choice for sperm extraction. Open TESE was performed only after a negative TESA attempt. Clinical pregnancy and live birth rates were determined. Results: A total of 106 testicular procedures were performed. Sperm was found in 95 cycles (89.6%). The average metaphase II (MII) oocyte number was 11.0 ± 4.2, an average of 5.1 ± 2.3 oocytes became normally fertilized after Intra Cytoplasmic Sperm Injection (ICSI) (fertilization rate 57.1%). On average, 2.7 ± 1.2 embryos were replaced. The clinical pregnancy rate was 32/106 (30.2%) per cycle and 19/32 (59.3%) per couple. Live birth rate was 62.5% (20/32). Conclusions: TESA/E and IVF can provide excellent prognosis for SCI patients that cannot be treated by EEJ or PVS.

Fertility in men with spinal cord injury

“…These results have been confirmed recently following TESE and ICSI in SCI patients after repeated trials of EEJ or PVS with the clinical pregnancy rate of 30.2% per cycle and 59.3% per couple and live birth rate of 62.5% [12]. Although some studies [42,43,53] don't recommend freezing sperm in SCI patients, the results of ICSI outcomes using frozen/thawed sperm obtained after PVS or surgical sperm retrieval may be encouraging (pregnancy rates per couple 50% versus 75%) and cryopreservation could be performed in such patients as a preventive measure [11].…”

“…When the number of motile sperm is too low for conventional IVF, the method of ICSI is often used to achieve fertilization [13]. These procedures can be performed in patients whose ejaculated sperms were obtained by PVS versus EEJ [9,11,[47][48][49], whereas after surgical sperm retrieval from the testicle, the epididymis and the vas deferens IVF or ICSI is mandatory [9,12,13]. The choice of assisted technology for patients with SCI is currently controversial, because it can be started directly by surgical sperm retrieval from reproductive tissue and followed by IVF/ICSI as a first line of treatment for anejaculation, bypassing examination of the ejaculate due to a lack of EEJ or PVS training and equipment [12,13,31].…”

“…These procedures can be performed in patients whose ejaculated sperms were obtained by PVS versus EEJ [9,11,[47][48][49], whereas after surgical sperm retrieval from the testicle, the epididymis and the vas deferens IVF or ICSI is mandatory [9,12,13]. The choice of assisted technology for patients with SCI is currently controversial, because it can be started directly by surgical sperm retrieval from reproductive tissue and followed by IVF/ICSI as a first line of treatment for anejaculation, bypassing examination of the ejaculate due to a lack of EEJ or PVS training and equipment [12,13,31]. Otherwise, since the majority of these patients have reasonable yields of total mobile sperms obtained by PVS or EEJ, it is advisable to begin with PVS as the first choice of treatment for semen retrieval, because the equipment is less expensive and administration is easier than EEJ and perform intravaginal or IUI if the total sperm count is sufficient [7,31].…”

“…By using various medical, technical and surgical methods for sperm retrieval with or without assisted reproductive techniques, numerous studies have reported reasonable fertility potential for men with SCI. The coincident application of assisted reproductive technology to these couples has yielded reproductive outcomes similar to those in able-bodied subfertile cohorts with reasonable pregnancy rates [9][10][11][12][13]. The purpose of the review is to analyse current management regimens responsible for impaired reproductive function as well as later fertility in men with SCI.…”

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

“…All patients evaluated in the present study had undergone unsuccessful PVS at other medical institutions, because ejaculation could not be induced. The use of EEJ is not yet covered by social insurance in Japan, thus at our facility, TESE‐ICSI is the standard treatment for patients with SCI‐related anejaculation who want to father biological children . Furthermore, even when ejaculation has been induced, decreases in sperm motility and survival rates, the presence of white blood cells in semen, and increases in sperm DNA fragmentation index values have been identified in SCI patients through the evaluation of semen quality .…”