Treatment of infertility due to anejaculation in the male with electroejaculation and intracytoplasmic sperm injection

Purpose: We tested the hypothesis that spinal cord injury and/or anejaculat ion affects the outcome of intracytoplasmic sperm injection (ICSI). Materials and Methods: From November 1993 to October 1998 we obtained and p rospectively reviewed data on 34 ICSI cycles using electroejaculated sperm, 620 male factor infertility ICSI cycles using normal ejaculated sperm and 120 cases of obstructive azoospermia, in which microsurgical epididymal asp iration and testicular sperm extraction-ICSI were done in 93 and 27, respec tively. Results: A total of 34 ICSI cycles were performed in 17 couples with male i nfertility due to anejaculation secondary to spinal cord injury in 10 patie nts and retroperitoneal lymph node dissection in 5, and idiopathic in 2. In all 17 couples at least 3 previous intrauterine insemination cycles had fa iled. After electroejaculation 11 men had oligozoospermia and 6 normal sper m density. Median sperm retrieval volume plus or minus standard deviation w as 1.9 +/- 1.9 ml., median sperm concentration 70.7 +/- 60.2 x 10(6) sperm per ml., median motility 10.7% +/- 10.8% and median forward progression 2.3 +/- 0.5 (scale 1 to 4). In the anejaculation group ICSI resulted in a medi an fertilization of 60% +/- 28%, 15% pregnancies per cycle and 29% pregnanc ies per couple. In the control group of 620 ICSI cycles from ejaculated spe cimens obtained from male patients with infertility median fertilization wa s 58% +/- 26%, and there were 39% pregnancies per cycle and 47% pregnancies per couple. The rate of pregnancies per embryo transfer and per couple was higher in the control than in the electroejaculation-ICSI group (p <0.05). However, there was no statistically significant difference in the fertiliz ation rate. Conclusions: ICSI or in vitro fertilization is a viable alternative for pat ients with anejaculation in whom intrauterine insemination failed. While th e fertilization rate is similar in these couples, the pregnancy rate is sig nificantly lower than that achieved with ejaculated specimens from patients with severe male factor infertility. ICSI is a viable alternative for a pa tient with anejaculation in whom intrauterine insemination or in vitro fert ilization failed.