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Treatment of infertility in men with spinal cord injury

Nature Reviews Urology volume 7, pages 162–172 (2010)Cite this article

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Abstract

Most men with spinal cord injury (SCI) are infertile. Erectile dysfunction, ejaculatory dysfunction and semen abnormalities contribute to the problem. Treatments for erectile dysfunction include phosphodiesterase type 5 inhibitors, intracavernous injections of alprostadil, penile prostheses, and vacuum constriction devices. In anejaculatory patients who wish to father children, semen retrieval is necessary. Penile vibratory stimulation is recommended as the first line of treatment. Patients who fail penile vibratory stimulation can be referred for electroejaculation. If this approach is not possible, prostate massage is an alternative. Surgical sperm retrieval should be considered as a last resort when other methods fail. Most men with SCI have a unique semen profile characterized by normal sperm count but abnormally low sperm motility. Scientific investigations indicate that accessory gland dysfunction and abnormal semen constituents contribute to the problem. Despite abnormalities, sperm from men with SCI can successfully induce pregnancy. In selected couples, the simple method of intravaginal insemination is a viable option. Another option is intrauterine insemination. The efficacy of intrauterine insemination increases as the total motile sperm count inseminated increases. In vitro fertilization and intracytoplasmic sperm injection are options in cases of extremely low total motile sperm count. Reproductive outcomes for SCI male factor infertility are similar to outcomes for general male factor infertility.

Key Points

  • Most men with spinal cord injury (SCI) are infertile owing to a combination of erectile dysfunction (ED), ejaculatory dysfunction, and semen abnormalities

  • Treatments to improve ED in the general population can be used to improve ED in men with SCI

  • Penile vibratory stimulation is recommended as the first line of treatment for anejaculation in men with SCI; patients who fail this therapy should be referred for electroejaculation

  • Men with SCI have a unique semen profile characterized by normal sperm concentration, but abnormally low sperm motility; dysinnervation of the accessory glands might lead to an abnormal seminal plasma environment

  • The same treatments that are effective for assisting conception in couples with non-SCI male factor infertility are effective in assisting conception in patients with SCI male factor infertility

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Figure 1: Mechanisms of erection.
Figure 2: A variety of devices can be used to induce ejaculation by penile vibratory stimulation.
Figure 3: Treatment options for patients who fail an initial session of penile vibratory stimulation (PVS).
Figure 4: Electroejaculation can be used to retrieve semen in men with spinal cord injury who fail penile vibratory stimulation.
Figure 5: Semen color in men with spinal cord injury (SCI).
Figure 6: Comparison of sperm motility in patients with and without SCI.

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Acknowledgements

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 Northwest 14th Terrace, Miami, 33136, FL, USA

    Nancy L. Brackett & Emad Ibrahim

  2. Department of Urology, University of Miami Miller School of Medicine, PO Box 016960, M814, Miami, 33101, FL, USA

    Charles M. Lynne

  3. Department of Urology, University of Michigan, 1500 East Medical Center Drive, Box 0330, Ann Arbor, 48108, MI, USA

    Dana A. Ohl

  4. Department of Urology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, Herlev, DK-2770, Denmark

    Jens Sønksen

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Correspondence to Nancy L. Brackett.

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D. A. Ohl declares that he has acted as a consultant for Eli Lilly, Endo Pharmaceutical, GlaxoSmithKline, Pfizer, Solvay and Watson, that he has received speakers bureau honoraria from Auxilium, Coloplast, Eli Lilly, Solvay and Watson, and that he has received grant/research support from American Medical Systems, Coloplast and Pfizer. J. Sønksen declares that he has been a stockholder/director of Multicept, and has acted as a consultant for Coloplast, Eli Lilly, and Pfizer. The other authors, the Journal Editor S. Farley and the CME questions author declare no competing interests.

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Brackett, N., Lynne, C., Ibrahim, E. et al. Treatment of infertility in men with spinal cord injury. Nat Rev Urol 7, 162–172 (2010). https://doi.org/10.1038/nrurol.2010.7

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