Pregnancy after assisted ejaculation procedures in men with spinal cord injury

Abstract

Objective: To present the results of fertility treatment in 28 men with spinal cord injury (SCI) and their partners. Design: Retrospective analysis. Setting: University hospital outpatient clinic and home. Patients: Twenty-eight anejaculatory men with SCI and their partners seeking treatment for infertility. Intervention: Penile vibratory stimulation and electroejaculation as semen, retrieval methods. Assisted reproductive techniques used: vaginal self-insemination at home, intrauterine insemination, in vitro fertilization with or without intracytoplasmic sperm injection. Main Outcome Measures: Ejaculation rate; sperm count and motility; pregnancy rates. Results: All of the men were able to ejaculate either by penile vibratory stimulation (79%) or electroejaculation (21%). Median total sperm count was 65 million (range, 0.1 to 480) with a median motility of 13% (range, 1% to 60%). Overall, 9 of 28 couples (32%) achieved 10 pregnancies (4 self-insemination, 3 intrauterine insemination, 1 in vitro fertilization, and 2 intracytoplasmic sperm injection). Conclusions: An ejaculation rate of 100% was achieved using penile vibratory stimulation as a first treatment option with electroejaculation as a second option. Motivated couples with adequate semen quality may be offered penile vibratory stimulation combined With self-insemination at home. Together with intrauterine insemination or fertilization techniques used in vitro, the pregnancy rate per treatment cycle for SCI couples may approach that of natural procreation in healthy and fertile couples.