Advances in the management of infertility in men with spinal cord injury

作     者：Emad Ibrahim Nancy L Brackett Charles M Lynne 

作者机构：The Miami Project to Cure Paralysis University of Miami Miller School of Medicine Miami FL USA Department of Urology University of Miami Miller School of Medicine Miami FL USA. 

出 版 物：《Asian Journal of Andrology》 (亚洲男性学杂志（英文版）)

年 卷 期：2016年第18卷第3期

页      面：382-390,I0007,I0008页

核心收录：

学科分类：0710[理学-生物学] 083002[工学-环境工程] 0830[工学-环境科学与工程（可授工学、理学、农学学位）] 07[理学] 08[工学] 09[农学] 071006[理学-神经生物学] 0903[农学-农业资源与环境] 0713[理学-生态学] 

主　　题：assisted reproductive technology ejaculation electroejaculation male infertility paraplegia penile vibratory stimulation semen sperm spinal cord injury surgical sperm retrieval 

摘      要：Couples with a spinal cord injured male partner require assisted ejaculation techniques to collect semen that can then be further used in various assisted reproductive technology methods to achieve a pregnancy. The majority of men sustaining a spinal cord injury regardless of the cause or the level of injury cannot ejaculate during sexual intercourse. Only a small minority can ejaculate by masturbation. Penile vibratory stimulation and electroejaculation are the two most common methods used to retrieve sperm. Other techniques such as prostatic massage and the adjunct application of other medications can be used, but the results are inconsistent. Surgical sperm retrieval should be considered as a last resort if all other methods fail. Special attention must be paid to patients with T6 and rostral levels of injury due to the risk of autonomic dysreflexia resulting from stimulation below the level of injury. Bladder preparation should be performed before stimulation if retrograde ejaculation is anticipated. Erectile dysfunction is ubiquitous in the spinal cord injured population but is usually easily managed and does not pose a barrier to semen retrieval in these men. Semen analysis parameters of men with spinal cord injury are unique for this population regardless of the method of retrieval, generally presenting as normal sperm concentration but abnormally low sperm motility and viability. When sperm retrieval is desired in this population, emphasis should be placed on initially trying the simple methods of penile vibratory stimulation or electroejaculation before resorting to more advanced and invasive surgical procedures.