Abstract
AbstractIn spinal cord injured (SCI) patients, three main factors may cause infertility: erectile dysfunction, ejaculatory dysfunction and impaired semen quality. This letter aims to discuss how we can manage SCI patients’ fertility in accordance with patient-centred care. For such SCI patients aged 20 to 40, having children represents hope for the future. Furthermore, it is a way to rebuild a life after the spinal injury and must be seen as an important part of the rehabilitation program. We suggest that sperm cryopreservation may contribute to patient-centred care management of SCI patients’ fertility, although there is no scientific evidence that cryopreservation will improve fertility outcome after SCI. Indeed, sperm cryopreservation is an affordable and simple technique in specialised centres with trained staff. Here, a protocol to manage SCI patients’ fertility is discussed: we propose PVS for sperm banking to all SCI patients after the phase of spinal shock during the rehabilitation program. If live sperm are retrieved, they are frozen and stored; however, if no live sperm are retrieved, electroejaculation and/or surgical sperm extraction are proposed only for patients who desire biological fatherhood. Prospective studies on the evolution of semen parameters, ejaculatory dysfunction, post-infectious obstructions and spermatogenesis impairment in chronic SCI patients are urgently needed to provide robust data for the evidence-based management of SCI patients’ fertility. Even if use rates are expected to be low, sperm banking may be a simple and affordable preventative measure for selected male SCI patients.
Highlights
Spinal cord injury (SCI) mainly affects young male patients, the majority of whom live for a long time with SCI and often wish to become fathers during their post-injury life [1]
According to two retrospective studies, semen parameters do not significantly decrease during the long-term evolution of SCI patients [1,4,5], which led the authors to conclude that fertility preservation by early sperm banking is not indicated in SCI patients
Most studies showed that assisted reproductive techniques (ART) management of SCI patients without systematic sperm banking leads to a mean live birth rate of 40% [30], which is comparable to the rates for non-SCI patients
Summary
Spinal cord injury (SCI) mainly affects young male patients, the majority of whom live for a long time with SCI and often wish to become fathers during their post-injury life [1]. According to two retrospective studies, semen parameters do not significantly decrease during the long-term evolution of SCI patients [1,4,5], which led the authors to conclude that fertility preservation by early sperm banking is not indicated in SCI patients. Kafetsoulis et al showed that in 28% of fertility centres, surgical sperm extraction, rather than semen retrieval, was used as a first line of treatment for the medical condition of anejaculation [6].
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