Abstract
BackgroundErectile dysfunction, ejaculatory dysfunction and poor semen quality are the main causes of infertility in men with spinal cord injury (SCI). Different sperm retrieval techniques such as penile vibratory stimulation (PVS), electro-ejaculation (EEJ) or surgical sperm retrieval (SSR) associated or not with sperm cryopreservation can be offered to these patients to preserve their fertility. If fatherhood cannot be achieved naturally, assisted reproductive techniques can be offered to these patients using either fresh or frozen/thawed sperm. The aim of the study was to report in SCI patients from Dijon (Burgundy) and in the literature, intracytoplasmic sperm injection (ICSI) outcomes using frozen sperm obtained either by antegrade ejaculation (PVS or sexual intercourse) or by SSR.MethodsA retrospective analysis was performed in Dijon, Burgundy over a 17 year period (1995-2011) on a cohort of 19 SCI men (6 quadriplegics and 13 paraplegics, mean age: 25.2 ± 5.6 years) who underwent a sperm cryopreservation followed or not by intracytoplasmic sperm injection (ICSI). Patients were divided into two groups according to the sperm retrieval method used (antegrade ejaculation group (n=10): penile vibratory stimulation (PVS) for 9 patients and sexual intercourse for 1 patient and surgical sperm retrieval (SSR) group: n=9). The sperm parameters in both groups were analyzed. Pregnancy outcomes in the 8 couples who underwent ICSI were evaluated.ResultsThe fertilization rates were 57 and 55%, the embryo’s cleavage rates were 90 and 93% in the antegrade ejaculation and SSR groups respectively. Among the 8 couples who underwent ICSI, 5 couples achieved pregnancy. The pregnancy rates per couple were 50% and 75% in the antegrade and SSR groups respectively.ConclusionsAlthough some studies don’t recommend freezing sperm in SCI patients, the pregnancy rates presented in this study are encouraging and warrant the use of frozen/thawed sperm in very specific situations.
Highlights
L’infertilité chez l’homme blessé médullaire s’explique d’une part par une dysfonction érectile et éjaculatoire et d’autre part par l’altération de la qualité des paramètres spermatiques
The aim of the present study was twofold: i) to investigate the results of intracytoplasmic sperm injection (ICSI) outcomes using frozen/thawed sperm obtained after penile vibratory stimulation (PVS) or surgical sperm retrieval (SSR) and ii) to compare our results with the ones published in the literature
Patients A retrospective analysis was performed on a cohort of 19 men with spinal cord injury (SCI) who underwent sperm cryopreservation in the CECOS (Centre d’Etudes de la Conservation des OEufs et du Sperme: Egg, Sperm Embryo banking) of Dijon’s Hospital from 1995 to 2011
Summary
L’infertilité chez l’homme blessé médullaire s’explique d’une part par une dysfonction érectile et éjaculatoire et d’autre part par l’altération de la qualité des paramètres spermatiques. Le but de ce travail a consisté à évaluer les issues de grossesses dans la littérature et sur une cohorte de patients de Dijon, blessés médullaires ayant eu recours à de la fécondation in vitro avec micro-injection (ICSI) à partir de spermatozoïdes cryoconservés éjaculés ou chirurgicaux. Les paramètres spermatiques ont été analysés ainsi que les issues de grossesses obtenues par ICSI réalisées avec des spermatozoïdes congelés. It is well known that following SCI, most men experience fertility-related problems because of impairments in erectile and ejaculatory functions and because of poor semen parameters. These men require medically assisted ejaculation (penile vibratory stimulation: PVS and electroejaculation: EEJ) in order to obtain a semen sample. In case of PVS and EEJ failure, surgical sperm extraction (SSR) can be performed
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