Fertility for men after spinal cord injury
There are two ways sperm can be collected from a man who has sustained a spinal cord injury. One is by using the a technique called vibrostimulation to induce ejaculation and the other is by collecting the sperm directly from the testis either under local or general anaesthetic.
Collection of sperm by ejaculation
Depending on the level of the spinal lesion, semen can be collected by penile stimulation using a vibratory device (vibrostimulation). This is usually performed in the presence of medical staff on the first occasion to ensure the complication of dysreflexia does not occur.
Collection of sperm by surgical recovery from the testis
If sperm cannot be collected by ejaculation, it may be recovered surgically from one or both testes under general or local anaesthetic, a technique known as Testicular Sperm Aspiration (TESA).
Recovery of sperm from the testis using a technique called microTESE (Testicular Sperm Extraction) can be performed under general anaesthetic. MicroTESE is indicated if sperm recovery has been very poor or absent using other techniques.
Using ejaculated sperm to achieve a pregnancy
The semen collected can be used for immediate transfer to the vagina. The semen can also be washed and placed directly into the uterus of the woman in a technique called intra-uterine insemination (IUI). These techniques require sperm of good quality and of sufficient number.
Ejaculated sperm can also be used in an in vitro fertilisation (IVF) cycle, either fresh or frozen. The quality of the sperm will determine whether standard IVF or intra-cytoplasmic sperm injection (ICSI) is recommended.
Using sperm that has been surgically extracted from the testis.
Sperm which has been surgically extracted from the testis can only be used by direct injection into the egg (ICSI). It can be frozen or used fresh on the day of egg collection.
What is the success rate?
Success depends on:-
- the age of the female partner
- if she has any other infertility issues
- the quality of the sperm
- the method used (IUI, IVF or ICSI)
- the number of previous cycles.
Success rates range between 10-42% per cycle depending on the factors listed above and the methods used.