In what is to our knowledge the largest study of its kind to date we retrospectively reviewed the records of 3,152 semen retrieval procedures in a total of 500 men with spinal cord injury to make recommendations to the medical field on ejaculatory dysfunction treatment in this specialized patient population.
We retrospectively studied data from 1991 to 2009 in the Miami Project to Cure Paralysis male fertility research program at our institution. We assessed the semen retrieval success rate and semen quality.
Of the 500 men 9% could ejaculate by masturbation. Penile vibratory stimulation was successful in 86% of patients with a T10 or rostral injury level. Electroejaculation was successful in most cases of failed penile vibratory stimulation. Sperm were obtained without surgical sperm retrieval, in 97% of patients completing the treatment algorithm. Total motile sperm counts exceeded 5 million in 63% of cases.
Sperm can be easily obtained nonsurgically from most men with spinal cord injury. Sufficient sperm are available for simple insemination procedures. A treatment algorithm based on our experience is presented.
"In SCI subjects, semen was collected by masturbation (n ¼ 1), PVS (n ¼ 21), or EEJ (n ¼ 8). Our protocols have been previously published for semen retrieval in men with SCI [Brackett et al. 2010a]. Control subjects produced semen via masturbation after 2-3 d of abstinence from ejaculation. "
[Show abstract][Hide abstract] ABSTRACT: Abstract Men with spinal cord injury have a unique semen profile characterized by normal sperm concentration but abnormally low sperm motility and viability. The purpose of our study was to determine if new diagnostic information could be obtained for this population by measuring serum concentrations of inhibin B and anti-Müllerian hormone. These hormones, as well as follicle stimulating hormone, luteinizing hormone, and testosterone, were measured in 30 men with spinal cord injury and 15 age-matched control subjects. Serum concentrations of inhibin B and testosterone were significantly lower in the spinal cord injury group compared to the control group. A statistically significant negative relationship was observed between serum concentrations of inhibin B and follicle stimulating hormone in both the spinal cord injury group and the control group, and between inhibin B and luteinizing hormone in the spinal cord injury group only. A significant positive relationship was also observed between inhibin B and sperm concentration in the spinal cord injury group. Although serum concentrations of inhibin B were significantly lower in the spinal cord injury group than in controls, inhibin B and anti-Müllerian hormone serum concentrations did not provide an additional diagnostic tool for male infertility in this population. This is the first study to determine serum concentrations of inhibin B and anti-Müllerian hormone in men with spinal cord injury.
Systems Biology in Reproductive Medicine 01/2015; 61(2):1-6. DOI:10.3109/19396368.2014.1002583 · 1.60 Impact Factor
"The diagnosis and characterisation of infertility as well as assisted fertilisation techniques are therefore important aspects in the urologic management of men with SCI. As a result of ejaculatory dysfunction, assisted ejaculation is required in more than 90% of men with SCI to obtain a sperm sample for analysis (Kafetsoulis et al., 2006; Brackett et al., 2010a). Penile vibratory stimulation is the first line method for assisted ejaculation, followed by transrectal electro-stimulation for nonresponders (DeForge et al., 2005). "
[Show abstract][Hide abstract] ABSTRACT: In this case series, the testicular resistive index was determined in men with spinal cord injury. In ten men participating in our fertility programme, the peak systolic and end-diastolic velocity of centripetal testicular arteries was measured in triplicates by Doppler ultrasonography to calculate the testicular resistive index. Furthermore, the right and left testicular volume was determined by ultrasonography, blood samples were obtained for hormonal evaluation, and sperm analysis was performed according to the WHO guidelines. The median testicular resistive index measured 0.69 and was significantly (P < 0.001) greater than the reported cut-off value of 0.6. The spermiograms were characterised by normal sperm count but decreased sperm motility and plasma membrane integrity. The median right and left testicular volume was significantly (P < 0.01) smaller compared to the volumes measured in able-bodied adult males without scrotal pathology and measured 8.4 ml and 7.2 ml respectively. There was a significant (P = 0.005) correlation (rs = 0.81) between testicular resistive index and sperm concentration. However, no correlations were observed between testicular resistive index and other variables. The testicular resistive index in men with spinal cord injury was significantly greater than 0.6. Measuring the testicular resistive index may represent a useful additional parameter in the assessment of infertility in spinal cord-injured men.
"Spinal cord injury can disrupt the nerve pathways responsible for ejaculation. Only about 9% of men with SCI can ejaculate through masturbation or intercourse [47, 48]. Consequently, most men with SCI require some form of medical assistance to procure sperm for insemination. "
[Show abstract][Hide abstract] ABSTRACT: Spinal cord injury (SCI) occurs most often to young men. Following SCI, most men are infertile due to a combination of erectile dysfunction, ejaculatory dysfunction and semen abnormalities. Erectile dysfunction may be treated by the same therapies that are used in the general population. Similarly, the same treatments that are effective to assist conception in couples with non-SCI male factor patients are effective in assisting conception in SCI male-factor patients. The most apparent differences in male-factor symptoms between SCI and non-SCI patients are the high occurrences of anejaculation and atypical semen profiles in men with SCI. Methods available to assist ejaculation in men with SCI include penile vibratory stimulation and EEJ. Use of surgical sperm retrieval as the first line of treatment for anejaculation in men with SCI is controversial. Most men with SCI have a unique semen profile characterized by normal sperm concentration, but abnormally low sperm motility. Toxic substances in the semen contribute to this problem. Despite impaired sperm parameters, pregnancy outcomes using sperm from men with SCI are similar to pregnancy outcomes using sperm from non-SCI men. Future studies should focus on improving natural ejaculation and improving semen quality in these men.
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