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Spinal Cord Injury Infertility

Majority of SCI patients cannot ejaculate during sex, with 9% able to ejaculate without intervention. Can use penile vibratory stimulation and electroejaculation to retrieve sperm. Reflex erections preserved in 95% of upper motor nerve damage, 5% with lower motor nerve damage. Most patients respond to PDE-5i.  Most SCI patients have normal sperm concentration with abnromally low motility and viability. Further studies have showed this was unchanged whether SCI patients sat in wheelchair or note and the seminal plasma from SCI patients may be negatively influence sperm quality. 

PENILE VIBRATORY STIMULATION (PVS)
If T6 or higher, have to be careful during stimulation because of autonomic dysreflexia and these patients should be pretreated with nifedipime (10-20mg) sublingual 10-15 min or 30-45min for PO before vibratory stimulation. 
Ferticare and Vibrerect X3 are two vibratory stimulation devices.  Applied for 2-3 minutes, stop and evaluate for skin abrasions or edema. This can be repeated up to 15 minutes total. Typically a response in 3 minutes.  If one device fails, can try 2 devices at same time, this salvage therapy works in 22% of those who fail with one.  PVS has an 86% success rate if T10 or higher lesion and 15% when T11 or lower. 

ELECTROEJACULATION
Rectal probe gives electrical current on prostate and seminal vesicles to stimulate ejaculation. If patient has sensation this can cause pain. 94% of patients respond, the other ones had pain and had to stop procedure.

RETROGRADE EJACULATION
Empty bladder w/ catheter, instill 25-50ml of sperm washing medium (ie Modified Human Tubal Fluid [HTF] with Human Serum Albumin [HSA]). This should be performed with any patient the first 1-2 times. If SPT in place, change SPT and lavage bladder 2-3 times before clamping SPT and proceeding. Cetrifuge collected urine post ejaculation and can perform lavage with sperm buffer if needed. 

OTHER SPERM RETRIEVAL OPTIONS
Other sperm retrieval options include open testis biopsy, percutaneous testicular biopsy, testicular sperm aspiration, epididymal sperm aspiration, microdissection TESE.
  1. Ibrahim, Emad, Nancy L. Brackett, and Charles M. Lynne. "Advances in the management of infertility in men with spinal cord injury." Asian journal of andrology 18.3 (2016): 382.
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