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Fertility Options After Spinal Cord Injury

Spinal Cord Injuries (SCIs) are a traumatic and life-changing medical condition and can have dramatic effects on fertility. Following SCI, input to and from the brain may be disrupted and is likely the reason why most men with SCI are unable to ejaculate during sex. The injury interferes with their ability to respond to normal sexual stimulation and to ejaculate in a normal manner

Several methods are available for sperm retrieval in spinal cord injury patients and must be used with Assisted Reproduction Techniques (ART) to have a child.

SCI Sperm Retrieval with Electroejaculation (EEJ)

Electroejaculation (EEJ) is a procedure that is often used when PVS fails. During EEJ, the man with SCI is positioned on his side and a doctor inserts an electrical stimulation probe into the rectum. The doctor controls the amount of electrical stimulation delivered so that an ejaculation occurs. The ejaculation may dribble out rather than forcefully spurt from the penis. The length of time that the probe is in the rectum is approximately 10 minutes. The procedure is generally well tolerated and only 5% of men with SCI require sedation or anesthesia to reduce discomfort.

The Men’s Fertility Center of Austin is one of only a handful of locations in the country with the ability to safely perform electroejaculation therapy.  Although mainly intended for SCI patients, there is a use for the technology in some diabetic patients and in men with an inability to ejaculate for a variety of reasons.

Most men with SCI cannot ejaculate during sexual intercourse; medical procedures are required to obtain their semen.


SCI Sperm Retrieval with Masturbation

Masturbation is stimulation of the penis by some means other than sexual intercourse, such as with the hand or an artificial device. Masturbation may deliver a more intense stimulus to the penis than sexual intercourse, and thus may lead to ejaculation in some men with SCI allowing for sperm retrieval.

SCI Sperm Retrieval with Penile Vibratory Stimulation (PVS)

Penile vibratory stimulation (PVS) is a method in which a vibrator is applied to the head of the penis to stimulate ejaculation. There are a wide variety of vibrators available. For purposes of ejaculation in men with SCI, it is often important to know if the vibrator is “high” or “low” amplitude.  A high amplitude vibrator that is available by prescription is called the Ferticare® Personal. With proper instruction and possible concomitant use of a medication like Viagra, high rates of success can be achieved using PVS in sperm retrieval.

Penile vibratory stimulation (PVS) and rectal probe electroejaculation (EEJ) are two methods of retrieving semen from men with SCI who cannot ejaculate during intercourse.

Surgical Sperm Retrieval for SCI

Surgical Sperm Retrieval Surgical methods of sperm retrieval are recommended when PVS and EEJ are unsuccessful or unavailable. Sperm is made in the testicle and travels through the epididymis and vas deferens before reaching the outside of the body. Sperm can be obtained directly from the man’s reproductive tract using minor surgery.

SCI Sperm Retrieval via Prostate Massage

Prostate massage If PVS fails, and EEJ is not possible, prostate massage is an alternative to surgical sperm retrieval in men with SCI. In prostate massage, the physician inserts a finger into the patient’s rectum and pushes on the prostate gland and seminal vesicles to attempt to mechanically push sperm out through the ejaculatory ducts and urethra.

Micro Testicular Sperm Exploration (micro-TESE)

Micro testicular sperm exploration is the most extensive sperm extraction procedure and is only performed by specially trained male fertility specialists. This procedure often follows the microscopic epididymal sperm aspiration and involves an incision in the testicle itself and a careful microscopic exploration that can last several hours. The cells responsible for producing sperm are extracted and inspected microscopically to look for evidence of mature sperm production. This sperm can be frozen and used in conjunction with IVF.

Dr. Mistry has performed more advanced sperm aspiration procedures than anyone in Austin in the last 10 years. We use several different facilities depending on where you are referred.