Wednesday, May 24, 2006

Male Infertility & Spinal Cord Injury

Fertility in Men with Spinal Cord Injury; New Insights

In the United States, 80% of new injuries occur to males. 62% are 16-35 years old. Although reproductive function in women with SCI is generally normal, infertility is a major complication of SCI in men. 90% cannot father children via sexual intercourse.

Dr Bracket highlighted the fact that there are well established and effective treatment for both erectile dysfunction and ejaculatory dysfunction. Although, electroejaculation (EEJ) and vibratory stimulation (PVS) has demonstrated efficacy in the retrieval of sperm which is sufficient for intrauterine or even intravaginal insemination, Dr Bracket presented data demonstrating that nearly 2/3 of physicians recommend the utilization of testicular sperm acquisition techniques and in vitro fertilization and intracytolplasmic sperm injection for SCI patients. A review carried out by Dr Brackett indicated that 70% of all electroejaculation and 90% of PVS antegrade trials had sufficient sperm recovery for IUI. Most providers who do not offer electroejaculation or vibratory stimulation do so because of the lack of access to specialized equipment. Dr Bracket advocated that physician attempt to acquire ejaculated sperm using EEJ and PVS and utilized these specimens for IUI in the management of patients with SCI.

Editorial comment:
It is important to recognize that ejaculated sperm can and should be utilized when possible. Providers should ideally not utilize IVF and ICSI when less expensive and effective alternatives are available. However, the utilization of testicular sperm acquisition and IVF appears to be more widely available and will allow men with SCI to achieve parenthood.

By Harris M. Nagler, MD
Society for the Study of Male Reproduction by Harris Nagler