PREGNANCY ACHIEVED BY INTRACYTOPLASMIC SPERM INJECTION USING CRYOPRESERVED VASAL-EPIDIDYMAL SPERM FROM A MAN WITH SPINAL-CORD INJURY

Anejaculation and poor semen quality are two major causes of infertili ty in men with spinal cord injury (SCI). The poor motility of retrieve d sperm usually has low fertilization potential and is thought to be u nfavorable for cryopreservation, This report describes a pregnancy aft er intracytoplasmic sperm injection (ICSI) with cryopreserved vasal-ep ididymal sperm from a man with SCI and anejaculation. An attempt was m ade to obtain sperm through electroejaculation, but no motile sperm we re found in two trials. Therefore, the subject underwent vasal aspirat ion, The retrieved sperm had a concentration of 26 x 10(6)/mL and a mo tility of 3%. ICSI was considered to be the best choice for the couple , but the wife did not become pregnant in the first cycle of treatment . A successful pregnancy was achieved by ICSI in the second cycle usin g frozen-thawed sperm, supernumerary in the previous cycle, with a den sity of 5 x lO(6)/mL and 1% motility. A set of healthy twins, one boy and one girl, were delivered via cesarean section at 36 weeks of gesta tion. Complementary to other assisted reproductive techniques, ICSI ma y provide men with SCI a greater opportunity to father children. The s upernumerary sperm, regardless of quality, should be cryo preserved to avoid the necessity and risk of repeated assisted ejaculations and as pirations of the genital tract. (C) 1998 by the American congress of R ehabilitation Medicine and the American Academy of Physical Medicine a nd Rehabilitation.