Treatment of male infertility due to spinal cord injury using rectal probeelectroejaculation: the Israeli experience

Study design: Male infertility caused by anejaculation is common among pati ents with spinal cord injury (SCIP). The fertility options for SCIP have im proved impressively over the past 10 years. We present the Israeli experien ce in the treatment of infertility in a large series of SCIP. The issues wh ich are addressed include the treatment of ejaculatory dysfunction, seminal quality and fertility management in SCIP. Setting: Sexual rehabilitation clinic, Neuro-Rehabilitation department, She ba Medical Center, Israel. Methods: Between June 1992 and May 1998, a total of 84 consecutive SCIP wer e treated in our clinic with electro-ejaculation (EEJ), representing a samp le of the SCIP population, composed mostly of young men traumatically injur ed. The patients have sustained different levels and completeness of spinal injury. Among the patients 33 were interested in achieving pregnancy (39.3 %), while the rest were interested in determining fertility potential for f amily. With EEJ, a low-current stimulation of the ejaculatory organs via a rectal probe is done. The collected semen is used for fertility determinati on or for fertilization. Results: Eighty-four patients were treated by EEJ. Mean age was 31.3 and me an age at injury was 21.7. There were 29 cervical, 50 thoracic and five lum bar lesions. Sixty-three had complete injury (ASIA A) and 21 incomplete (AS IA B -15, ASIC C -5, ASIA D -1). Fifty-nine had upper motor neuron lesions, and 25 had lower motor neuron. A total of 355 stimulations were performed. Ejaculate was obtained in all patients in 350 stimulations (98.6%), and sp erm was present in 74 patients (88.1%) in 296 of the stimulations (83.4%). Fairly good numbers of spermatozoa were obtained, whereas sperm motility an d morphology of spermatozoa were low in most cases. A significant differenc e in sperm count, motility and morphology was noted between antegrade and r etrograde samples. No significant improvement in sperm quality after four r epeated consecutive stimulations was noted in 38 SCIP. Side effects were mi nor and encountered in 16 patients (19.1%). Out of 33 couples who wished to achieve pregnancy, 26 reached the stage of insemination. Four pregnancies were achieved after 33 cycles of In-Uterine-Insemination (pregnancy rate 28 .6% per couple), and 15 after 68 cycles of In-Vitro-Fertilization (microman ipulation) (pregnancy rate of 68.75% per couple). In all, of 101 conception attempts 23 were successful, resulting in pregnancies in 18 couples, and a ccounting for an overall pregnancy rate of 70% per couple. Conclusion: The high percentage of pregnancies imply that, despite the typi cally poor sperm motility noted in EEJ, rectal probe EEJ combined with assi sted reproductive techniques, and performed by a team approach, is an effic ient and safe technique for treating infertility among SCIP.