Current trends in the treatment of infertility in men with spinal cord injury

Kafetsoulis, Apostolos; Brackett, Nancy L.; Ibrahim, Emad; Attia, George R.; Lynne, Charles M.

doi:10.1016/j.fertnstert.2006.01.060

Next »Fertility and Sterility
Volume 86, Issue 4 , Pages 781-789, October 2006

Current trends in the treatment of infertility in men with spinal cord injury

Apostolos Kafetsoulis, M.D.
- Department of Urology, University of Ioannina, Ioannina, Greece
Nancy L. Brackett, Ph.D.
- Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
- Reprint requests: Nancy L. Brackett, Ph.D., Miami Project to Cure Paralysis; University of Miami School of Medicine, Lois Pope Life Center; 1095 NW 14th Terrace, Miami, Florida 33136 (FAX: 305-243-3913).
Emad Ibrahim, M.D.
- Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
George R. Attia, M.D.
- Division of Reproductive Endocrinology, University of Miami Miller School of Medicine, Miami, Florida
Charles M. Lynne, M.D.
- Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida

Received 10 October 2005; received in revised form 5 January 2006; accepted 5 January 2006. published online 11 September 2006.

Objective

To determine current use of penile vibratory stimulation (PVS), electroejaculation (EEJ), and intrauterine insemination (IUI) in treatment of infertility in men with spinal cord injury (SCI).

Design

Prospective survey, retrospective chart review, and literature review.

Setting

Major university medical center.

Patient(s)

Male SCI patients and female partners.

Intervention(s)

A survey administered to professionals determined current treatment methods for infertility in couples with SCI male partners.

Main Outcome Measure(s)

Sperm retrieval methods, ejaculation success rates, total motile sperm (TMS), IUI application, and IUI outcomes.

Result(s)

Twenty-eight percent of surveyed professionals do not retrieve sperm from ejaculates of SCI patients, relying instead on retrieval from reproductive tissues. Reasons for not offering PVS or EEJ were lack of familiarity, training, or equipment. Thirty-four percent do not offer IUI to these couples. Chart review showed that semen could be retrieved by PVS or EEJ in 95% of patients. Fifty-three percent and 43% of trials had TMS >5 and >10 × 10⁶, respectively. Of survey respondents performing IUI, 42% lacked enough data to estimate pregnancy rates (PRs) in these couples. Literature review showed IUI PRs between 9% and 18% per cycle and 30% and 60% per couple.

Conclusion(s)

Based on ejaculation success rates, TMS yields, and IUI outcomes, the methods of PVS, EEJ, and IUI warrant consideration in centers not currently offering these options for couples with SCI male partners.

Key Words: Spinal cord injuries, infertility, electroejaculation, sperm, PVS, IUI, IVF, pregnancy, ejaculation, semen