A comprehensive approach to the management of male infertility following spinal cord injury

Objectives: To review the outcomes of management of male infertility follow ing spinal cord injury in a specialised fertility clinic. Study Design: Retrospective review of medical records. Setting: The Fertility Clinic of a 45-bed spinal cord injury service in New South Wales, Australia. Methods: The medical and fertility clinic records of 113 males who attended the clinic between 1987 and 1997 were reviewed. Results: The rates of semen retrieval using vibroejaculation and electroeja culation were 67% and 97% respectively. Thirty-one individuals (37%) and th eir partners sought assistance with the primary aim of achieving a pregnanc y. Intravaginal insemination (IVI) undertaken at home following vibroejacul ation resulted in a pregnancy rate per cycle of 22%. Electroejaculation and IVI proved less successful with a pregnancy rate per cycle of only 5%, alt hough with intrauterine insemination (IUI) this rate improved to 30%. Micro manipulation in vitro fertilisation (IVF) procedures, primarily intracytopl asmic sperm injection, were used in 18 couples resulting in-a pregnancy. ra te per cycle of 19%. In the 31 couples there have been a total of 17 pregna ncies in 97 cycle attempts for an overall pregnancy rate per cycle of 18% a nd a cumulative pregnancy rate per couple of 55%. Twelve of the pregnancies have resulted in 14 live births (including two sets of twins), there were three pregnancies ongoing at the date of review and there have been two spo ntaneous abortions. Conclusion: The benefits of a specialised fertility clinic offering a compr ehensive, client-focused approach with education, fertility assessment and a range of semen retrieval and assisted reproduction options, are highlight ed.