Fertility in men with spinal cord injury

Abstract

Young men comprise the overwhelming majority of men with spinal cord injury (SCI), the incidence of which has been growing over the years. Due to advances in physical medicine and rehabilitation, remarkable improvements in survival rates have been reported, leading to life expectancies similar to those of the general population. However, many sexual and reproductive functions may be impaired due to erectile or ejaculatory dysfunction and semen abnormalities, characterised by low-sperm motility or viability in SCI males who have not become parents yet. Nevertheless, fatherhood is still possible through the introduction of specialised medical management, by using various medical, technical and surgical methods for sperm retrieval in combination with assisted reproductive techniques. Erectile dysfunction can be managed by the use of phosphodiesterase-5 inhibitors, intracavernosal injections, vacuum devices and penile prostheses. Semen can be obtained from the vast majority of anejaculatory men by medically assisted ejaculation through the use of penile vibratory stimulation or electroejaculation and via prostate massage or surgical procedures. Despite impaired sperm parameters, reasonable pregnancy rates similar to those in able-bodied subfertile cohorts have been reported. However, future research should focus on the optimisation of semen quality in these men and on improving natural ejaculation.

Chinese abstract

脊髓损伤 (SCI) 的男性中年轻男性占绝大多数, 其发病率在这些年来呈持续增长。由于物理治疗与康复医学的进步, 已有报道其存活率显著提高, 导致其预期寿命接近一般人群。然而, 在一些还未为人父的SCI男性患者中, 由于勃起或射精障碍、精液异常导致许多患者性功能和生殖功能可能受损, 其中精液异常以较低的精子活力和精子活率为特点。尽管如此, 仍有可能通过引进专业医疗方法使患者有做父亲的机会, 即利用各种医疗、技术和手术方法同时联合辅助生殖技术达到精子获取。勃起功能障碍可以通过应用磷酸二酯酶-5抑制剂、海绵体内注射、真空抽吸和阴茎假体植入治疗。绝大多数射精障碍的男性可以通过阴茎振动刺激或电刺激采精的使用及通过前列腺按摩或手术等医疗辅助方法获得精液。尽管精液参数异常, 但已有报道这种方法的合理妊娠率与体健的低生育力人群相似。然而, 未来的研究应该集中在这些男性的精液质量的优化和自然射精的改善。

Keywords:

• Asthenospermia
• erectile and ejaculatory dysfunction
• fertility
• spinal cord injury

Declaration of interest

The authors report no declarations of interest.