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

Abstract

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.

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

“…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.…”

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

“…The mean age of the female partners was 34.5 ± 4.66 years (range 26-44). The mean age at injury of the male partners was 21.7±4.3 years and the average interval till the ART procedure was carried out was 7.6±2.1 years (range [5][6][7][8][9][10][11][12][13][14][15][16].…”

“…[4][5][6][7][8][9] In our previous study, by using EEJ combined with assisted reproductive technique (ART), we showed high percentage of pregnancies despite the typically poor sperm motility. 10 In cases where azoospermia was evident during initial evaluation, the only option to conceive was to perform testicular biopsy for sperm retrieval and IVF. In the present study, we have summarized the IVF outcome in a group of such azoospermic SCI patients.…”

Convergence of multiple pelvic organ inputs in the rat rostral medulla

“…One example of a process in which coordination is important is ejaculation, which consists of emission of the seminal fluid from the ejaculatory ducts to the proximal urethra, bladder neck closure and anterograde ejaculation out of the proximal urethra (Seftel et al 1991;Truitt & Coolen, 2002). Disruption of this coordination, such as following spinal cord injury, results in the failure of bladder neck closure and thus a subsequent retrograde ejaculation leading to infertility (Heruti et al 2001).Another example in which coordination between the pelvic organs is important is during voiding of the urinary bladder, which requires contraction of the external anal sphincter, thereby preventing defaecation. In humans, distension of the urinary bladder produces contractions of the anal sphincter (Basinski et al 2003).…”