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Čehić E, Cerovac A, Zulović T, Begić E. Reproductive characteristics and success rate of intracytoplasmic sperm microinjection in spinal cord injury infertile men: Retrospective cohort study. Technol Health Care 2024:THC240518. [PMID: 39058468 DOI: 10.3233/thc-240518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND Thanks to modern methods of assisted reproduction (ART), parenthood has become an attainable goal for couples in which the male partner has experienced spinal cord injury (SCI). OBJECTIVE The aim of our study was to determine the success of the treatment of infertile patients with SCI with intracytoplasmic sperm injection (ICSI) of cryopreserved sperm obtained by the testicular sperm aspiration (TESA) procedure. METHODS In this retrospective study 156 infertile couples were included, in which the male partner is primarily infertile due to azoospermia. Infertile couples were divided into two groups. The first group (n= 82) includes men with SCI, and the second (n= 74) men with obstructive azoospermia (OA) as the cause of infertility. All infertile men were examined and processed in the diagnostic procedure, and based on the urological findings, surgical extraction of sperm from the testicles was indicated. Exclusion criteria were the age of women over 40 and men over 45. RESULTS We found that the quality of sperm was worse in the group with SCI, compared to the group with OA, but without statistical significance. Zenica and Johnsen score (p= 0.001; p= 0.000) showed worse semen characteristics in the group with SCI. There were no significant differences in the average number of embryos (p= 0.698), pregnancy rates per cycle (p= 0.979) and pregnancy rates per embrio transfer (ET), clinical pregnancy rates per ET (p= 0.987) and delivery rates per ET (p= 0.804) in couples with SCI, compared to couples with OA. CONCLUSION Based on the results of this research, the TESA and ICSI procedures can be recommended as a successful method in the treatment of male infertility caused by azoospermia due to SCI.
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Affiliation(s)
- Ermin Čehić
- Department of Human Reproduction, Menopause and Aesthetic Gynecological Endocrinology, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
- Department of Gynecology and Obstetrics, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina
| | - Anis Cerovac
- Department of Gynecology and Obstetrics, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina
- Department of Gynecology and Obstetrics, General Hospital Tešanj, Tešanj, Bosnia and Herzegovina
| | - Tarik Zulović
- Department of Gynecology and Obstetrics, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina
- Department of Gynecology and Obstetrics, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
| | - Edin Begić
- Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
- Department of Cardiology, General Hospital "Prim. Dr. Abdulah Nakas", Sarajevo, Bosnia and Herzegovina
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Ranjith S, Dave A. Filling the Gaps in Oncofertility Care by Addressing Challenges Faced by Patients and Providers. Cureus 2023; 15:e50219. [PMID: 38192954 PMCID: PMC10773274 DOI: 10.7759/cureus.50219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024] Open
Abstract
With enhanced technology and upcoming treatment strategies in the cancer field, the survival rates of patients have increased. We have now reached a stage in the treatment of cancer where we not only address the disease but also address complications that arise due to the disease and the side effects that present in the post-survival population due to its treatment. One of the primary consequences after oncotherapy is infertility, which is a major reason for distress for patients' post-survival, as they are afraid they may be deemed as less desirable, be rejected by their existing partner, or cannot grapple with the fact that they cannot have children of their own. This can be avoided by the implementation of proper oncofertility practices. The subject of oncofertility involves interactions between experts in the domains of cancer diagnosis, therapy, fertility preservation, and reproductive health. It attempts to investigate and broaden the possibilities for cancer survivors' reproductive future in order to suit their needs according to their ethical religious and sociocultural beliefs. However, these practices are often not implemented effectively due to ineffective doctor-patient communication, lack of knowledge, or partial knowledge of clinicians themselves regarding fertility care. This leads to a feeling of insecurity among clinicians hence resulting in them not referring patients. Lack of awareness among doctors of different oncofertility procedures available especially for patient groups like women and younger patients, hence leading to reduced referral in these groups. Improper coordination across health departments, patient ignorance regarding procedures, financial instability especially in a country with a lower sociodemographic index like India, and neglect or less importance given to the related ethical, social, and legal issues. In this article, we cover the effects of cancer and cancer treatment on fertility, the options available to adult and pediatric cancer patients to preserve their fertility like oocyte/ovarian tissue cryopreservation in females and sperm cryopreservation in males, techniques undergoing experimental studies that could be implemented in the future like spermatogonial stem culture and transplantation of testicular tissue, the obstacles that we face that hinder the proper implementation of such practices and what measures can we take to overcome these obstacles to improve patient care and be better healthcare providers.
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Affiliation(s)
- Saanthwana Ranjith
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Apoorva Dave
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Ibrahim E, Brackett NL, Lynne CM. Penile Vibratory Stimulation for Semen Retrieval in Men with Spinal Cord Injury: Patient Perspectives. Res Rep Urol 2022; 14:149-157. [PMID: 35480782 PMCID: PMC9037179 DOI: 10.2147/rru.s278797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022] Open
Abstract
Spinal cord injury (SCI) is a catastrophic event with sequelae that are not often apparent. For the spinal cord injured man, the inability to become a biologic father because of reproductive dysfunction becomes a major negative factor in his self-esteem and a hindrance to his social rehabilitation. Approximately, 90% of men with SCI develop ejaculatory dysfunction and only 10% can ejaculate by masturbation or during sexual activity. It is only over the last 40 years that it has been possible to properly study and understand the various factors contributing to the problem. Advances have been made in governmental and societal attitudes that have led to improvements in the treatment and rehabilitation of persons with SCI and other disabilities. It is now possible to retrieve sperm reliably and safely from men with SCI. Although their semen quality is often impaired, there is a very reasonable chance for achieving biologic fatherhood using assisted reproductive techniques. Penile vibratory stimulation (PVS) is a safe, reliable, efficient, and cost-effective, method of sperm retrieval that will produce an ejaculate in up to 86% of the patients with a level of injury T10 or rostral, which accounts for approximately 80% of the SCI population. Some motile sperm will be present in 90% of these ejaculates. In approximately 75% of the ejaculates, there will be greater than 5 million motile sperm, allowing a couple to explore all the options available to a couple seeking help in conceiving a child. The Male Fertility Program of the Miami Project to Cure Paralysis is at the leading edge of basic and clinical research contributing to the management of infertility in men with SCI. This review will outline “how we got there” enabling us to recommend PVS as the first choice in assisting men with SCI to become biologic parents.
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Affiliation(s)
- Emad Ibrahim
- The Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
- Correspondence: Emad Ibrahim, The Desai Sethi Urology Institute/The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, 1611 NW 12th Ave, 2nd floor, Rm 2.147, Miami, FL33136, USA, Tel +1 305 243 9083, Fax +1 305 243 3913, Email
| | - Nancy L Brackett
- The Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Charles M Lynne
- The Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
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4
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Naredi N, Agrawal A. From disability to fatherhood: Journey of serving soldiers with spinal cord injury. Med J Armed Forces India 2021; 77:444-451. [PMID: 34594074 DOI: 10.1016/j.mjafi.2021.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 01/11/2021] [Indexed: 11/19/2022] Open
Abstract
Background Apart from neurological consequences, most distressing sequels of spinal cord injury (SCI) in men are erectile dysfunction, ejaculatory dysfunction and abnormal semen quality. Of these, ejaculatory dysfunction and poor semen parameters pose the biggest challenge to their biological fatherhood. Penile vibratory stimulation (PVS) and electroejaculation are first-line modalities for anejaculation, and surgical sperm retrieval (SSR) is adopted when other treatments fail. Sperms obtained using these techniques can be used for various fertility treatments for couples with spinal cord injured men. The aim of the study was to study the effectiveness of various modalities of sperm retrieval for assisted reproductive treatment in men with SCI. Methods It was a prospective observational study, wherein partners of 12 men with SCI presenting for subfertility underwent assisted reproduction after retrieving sperms via various modalities. The primary outcome was to assess efficacy of PVS in obtaining sperms and of SSR if PVS failed. The secondary outcome was to assess the pregnancy rate in their partners. Results PVS was successful in obtaining ejaculate in 7 of 12 men, and SSR was fruitful in 4 of 5 men. In vitro fertilization cycle for men who underwent PVS resulted in a pregnancy rate of 57.14% and 75% in couples for men who underwent SSR with an overall pregnancy rate of 58.33%. Conclusion With new cases of SCI occurring primarily in young men at the peak of their reproductive health, it is imperative that medical professionals involved with reproductive health should be aware of the various modalities to help them achieve biological paternity.
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Affiliation(s)
- Nikita Naredi
- Senior Advisor (Obst & Gynae) & ART Specialist, ART Centre, Military Hospital, Bhopal, India
| | - Amit Agrawal
- Senior Advisor (Surgery) & Urologist, Command Hospital (Western Command), Chandimandir, Haryana, India
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Wiggins JW, Sledd JE, Coolen LM. Spinal Cord Injury Causes Reduction of Galanin and Gastrin Releasing Peptide mRNA Expression in the Spinal Ejaculation Generator of Male Rats. Front Neurol 2021; 12:670536. [PMID: 34239493 PMCID: PMC8258150 DOI: 10.3389/fneur.2021.670536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/21/2021] [Indexed: 01/23/2023] Open
Abstract
Spinal cord injury (SCI) in men is commonly associated with sexual dysfunction, including anejaculation, and chronic mid-thoracic contusion injury in male rats also impairs ejaculatory reflexes. Ejaculation is controlled by a spinal ejaculation generator consisting of a population of lumbar spinothalamic (LSt) neurons that control ejaculation through release of four neuropeptides including galanin and gastrin releasing peptide (GRP) onto lumbar and sacral autonomic and motor nuclei. It was recently demonstrated that spinal contusion injury in male rats caused reduction of GRP-immunoreactivity, but not galanin-immunoreactivity in LSt cells, indicative of reduced GRP peptide levels, but inconclusive results for galanin. The current study further tests the hypothesis that contusion injury causes a disruption of GRP and galanin mRNA in LSt cells. Male rats received mid-thoracic contusion injury and galanin and GRP mRNA were visualized 8 weeks later in the lumbar spinal cord using fluorescent in situ hybridization. Spinal cord injury significantly reduced GRP and galanin mRNA in LSt cells. Galanin expression was higher in LSt cells compared to GRP. However, expression of the two transcripts were positively correlated in LSt cells in both sham and SCI animals, suggesting that expression for the two neuropeptides may be co-regulated. Immunofluorescent visualization of galanin and GRP peptides demonstrated a significant reduction in GRP-immunoreactivity, but not galanin in LSt cells, confirming the previous observations. In conclusion, SCI reduced GRP and galanin expression in LSt cells with an apparent greater impact on GRP peptide levels. GRP and galanin are both essential for triggering ejaculation and thus such reduction may contribute to ejaculatory dysfunction following SCI in rats.
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Affiliation(s)
- James W Wiggins
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, United States.,Graduate Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, United States
| | - Jonathan E Sledd
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, United States
| | - Lique M Coolen
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, United States.,Department of Biological Sciences, Kent State University, Kent, OH, United States
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6
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Abstract
When working with LGBTQ+ patients who want to build families, primary care providers play a key role in increasing access to reproductive health care. There is growing demand for assisted reproductive services among LGBTQ+ individuals who do not already have their own children or do not wish to adopt. Fertility-preservation options are available for transgender patients; however, many of these treatments are inaccessible to patients because of lack of insurance coverage and high cost. Legal options for LGBTQ+ patients' reproduction vary by state. Knowledge of the laws and regulations in your own state of practice is necessary to manage expectations.
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Affiliation(s)
- Melissa N Montoya
- Department of Obstetrics and Gynecology, Duke University School of Medicine, 201 Trent Drive, 203 Baker House, Durham, NC 27710, USA
| | - Benjamin J Peipert
- Department of Obstetrics and Gynecology, Duke University School of Medicine, 201 Trent Drive, 203 Baker House, Durham, NC 27710, USA
| | - Dane Whicker
- Department of Psychiatry and Behavioral Sciences, 2213 Elba Street, Durham, NC 27710, USA
| | - Beverly Gray
- Department of Obstetrics and Gynecology, Duke University School of Medicine, 201 Trent Drive, 203 Baker House, Durham, NC 27710, USA.
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Mulawkar PM, Maheshwari PN, Agrawal SG. Clinical Andrologists: Do We Really Need Them in the Era of ART? J Hum Reprod Sci 2021; 14:105-112. [PMID: 34316224 PMCID: PMC8279053 DOI: 10.4103/jhrs.jhrs_66_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/16/2021] [Accepted: 05/16/2021] [Indexed: 11/29/2022] Open
Abstract
Infertility is on a rise, and so is the availability of assisted reproductive technique (ART) centres. The sole aim of these centers is to help these unfortunate couples achieve pregnancy. Hence, the concentration of the treatment is on the female partner, while the male is relegated to just being a source for sperm. In the era of intracytoplasmic sperm injection, when pregnancy is possible even with a single mature sperm, evaluation and management of male factor infertility (MFI) is often neglected. MFI and poor semen parameters are markers of male health. He could be suffering from erectile or ejaculatory issues or with correctable obstructive azoospermia. A simple timely varicocele correction may help resolve the issue. It is important to understand that MFI is not a disease but may be a symptom of major underlying clinical condition like testicular or brain tumors. Infertility treatment could be the only occasion when a male seeks health-care evaluation. India has a large pool of qualified urologists trained in andrological care. In contrast, gynecologists may not be trained in the management of male patients, hence there is an important place for andrological services to be an integral part of ART centers. Andrologists would offer minimal andrological evaluation and condition-specific treatment. This could avoid or reduce the need for invasive and expensive ART. Andrologists could also choose the most appropriate mode of sperm retrieval. Undoubtedly, availability of andrological services would improve the overall quality of care, reduce the costs and complications, and would also be medicolegally safe.
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Affiliation(s)
- Prashant Motiram Mulawkar
- Department of Urology, Tirthankar Superspeciality Hospital, Akola, Maharashtra, India
- Department of Urology, University of Edinburgh, Edinburgh, Scotland, UK
| | - Pankaj N. Maheshwari
- Department of Urology, Fortis Hospital, Mumbai, Maharashtra, India
- Department of Urology, Grant Medical College, Mumbai, Maharashtra, India
| | - Sumeet Gopal Agrawal
- Department of Urology, Tirthankar Superspeciality Hospital, Akola, Maharashtra, India
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8
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Nassau DE, Ramasamy R. Sperm retrieval options for men with spinal cord injury. Fertil Steril 2021; 115:1190. [PMID: 33757670 DOI: 10.1016/j.fertnstert.2021.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Daniel E Nassau
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
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9
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Sexual Health in the Neurogenic Patient. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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10
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Yu B, Darves-Bornoz AL, Brannigan RE, Halpern JA. Acute anejaculation, hypogonadism, and fertility preservation in the setting of neurosarcoidosis: case report and literature review. F S Rep 2020; 1:317-325. [PMID: 34223263 PMCID: PMC8244293 DOI: 10.1016/j.xfre.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To examine fertility preservation techniques in the setting of neurosarcoidosis, and to review the impact of corticosteroid and methotrexate therapy on fertility. Design Case report of a patient with infertility secondary to anejaculation associated with spinal neurosarcoidosis, treated with systemic corticosteroids and methotrexate. Setting Academic tertiary-care hospital. Patient(s) A 39-year-old man presented with neurosarcoidosis complicated by acute anejaculation, erectile dysfunction, and hypogonadism. He underwent fertility consultation and sperm cryopreservation before initiating methotrexate therapy. His pretreatment total testosterone was low, at 157 ng/dL. Intervention(s) Unsuccessful pharmacologic therapy and penile vibratory stimulation (PVS) were followed by microdissection testicular sperm extraction (microTESE). Clomiphene was administered for optimization of spermatogenesis before microTESE. Main Outcome Measure(s) Vials of cryopreserved sperm, testis histopathology, and serum testosterone levels. Result(s) Eight vials of viable sperm were harvested by means of micro-TESE and cryopreserved. Despite intraoperative appearance of hypospermatogenesis, 90% of seminiferous tubules had active germ cell sloughing. Total testosterone increased to 278 ng/dL 2 months after initiating clomiphene. Conclusion(s) Conventional fertility preservation techniques may be effective in the setting of neurosarcoidosis-induced infertility owing to largely intact spermatogenesis. PVS, though not effective for this patient, should be considered along with electroejaculation, given high success rates in other patients with neurogenic anejaculation. Corticosteroid-mediated hypogonadism also must be considered in these patients, because it can negatively affect downstream spermatogenesis. In addition, evidence for the impact of paternal methotrexate exposure on fertility is limited and requires further investigation. As such, fertility consultation before initiating methotrexate is highly recommended.
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Affiliation(s)
- Benjamin Yu
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anne L Darves-Bornoz
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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11
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Fertility Preservation for the Transgender Individual. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2020. [DOI: 10.1007/s13669-020-00291-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Halpern JA, Das A, Faw CA, Brannigan RE. Oncofertility in adult and pediatric populations: options and barriers. Transl Androl Urol 2020; 9:S227-S238. [PMID: 32257863 PMCID: PMC7108982 DOI: 10.21037/tau.2019.09.27] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Cancer and its treatments can affect fertility in a variety of ways, and recent advances in cancer detection and treatment have led to an increasing number of cancer survivors for whom future fertility is a primary concern. Oncofertility is the study of interactions between cancer, anti-cancer therapy, fertility, and reproductive health. Fertility preservation aims to optimize fertility potential before initiation of gonadotoxic therapies. Sperm cryopreservation from an ejaculated sample is the gold standard for adults and post-pubertal adolescents, though added maneuvers such as medical therapy, penile vibratory stimulation, and electroejaculation can be employed when appropriate. When all these approaches fail, testicular sperm extraction can be used to obtain and cryopreserve testicular sperm from the azoospermic patient. Fertility preservation in the pre-pubertal pediatric patient is still experimental, but recent scientific breakthroughs with use of spermatogonial stem cells and testicular tissue transplantation offer great promise for the future. While there may be several practical, cultural, religious, and other barriers to fertility preservation, the establishment of a dedicated fertility preservation team can help to overcome these obstacles and optimize the utilization of fertility preservation in cancer patients of all ages.
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Affiliation(s)
- Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Arighno Das
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cory A Faw
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Baram S, Myers SA, Yee S, Librach CL. Fertility preservation for transgender adolescents and young adults: a systematic review. Hum Reprod Update 2019; 25:694-716. [DOI: 10.1093/humupd/dmz026] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/21/2019] [Accepted: 07/14/2019] [Indexed: 12/17/2022] Open
Abstract
Abstract
BACKGROUND
Many transgender individuals choose to undergo gender-affirming hormone treatment (GAHT) and/or sex reassignment surgery (SRS) to alleviate the distress that is associated with gender dysphoria. Although these treatment options often succeed in alleviating such symptoms, they can also negatively impact future reproductive potential.
OBJECTIVE AND RATIONALE
The purpose of this systematic review was to synthesize the available psychosocial and medical literature on fertility preservation (FP) for transgender adolescents and young adults (TAYAs), to identify gaps in the current research and provide suggestions for future research directions.
SEARCH METHODS
A systematic review of English peer-reviewed papers published from 2001 onwards, using the preferred reporting items for systematic reviews and meta-analyses protocols (PRISMA-P) guidelines, was conducted. Four journal databases (Ovid MEDLINE, PubMed Medline, Ovid Embase and Ovid PsychINFO) were used to identify all relevant studies exploring psychosocial or medical aspects of FP in TAYAs. The search strategy used a combination of subject headings and generic terms related to the study topic and population. Bibliographies of the selected articles were also hand searched and cross-checked to ensure comprehensive coverage. All selected papers were independently reviewed by the co-authors. Characteristics of the studies, objectives and key findings were extracted, and a systematic review was conducted.
OUTCOMES
Included in the study were 19 psychosocial-based research papers and 21 medical-based research papers that explore fertility-related aspects specific for this population. Key psychosocial themes included the desire to have children for TAYAs; FP discussions, counselling and referrals provided by healthcare providers (HCPs); FP utilization; the attitudes, knowledge and beliefs of TAYAs, HCPs and the parents/guardians of TAYAs; and barriers to accessing FP. Key medical themes included fertility-related effects of GAHT, FP options and outcomes. From a synthesis of the literature, we conclude that there are many barriers preventing TAYAs from pursuing FP, including a lack of awareness of FP options, high costs, invasiveness of the available procedures and the potential psychological impact of the FP process. The available medical data on the reproductive effects of GAHT are diverse, and while detrimental effects are anticipated, the extent to which these effects are reversible is unknown.
WIDER IMPLICATIONS
FP counselling should begin as early as possible as a standard of care before GAHT to allow time for informed decisions. The current lack of high-quality medical data specific to FP counselling practice for this population means there is a reliance on expert opinion and extrapolation from studies in the cisgender population. Future research should include large-scale cohort studies (preferably multi-centered), longitudinal studies of TAYAs across the FP process, qualitative studies of the parents/guardians of TAYAs and studies evaluating the effectiveness of different strategies to improve the attitudes, knowledge and beliefs of HCPs.
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Affiliation(s)
- Shira Baram
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario M5G 1N8, Canada
- Department of Obstetrics and Gynecology, University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S, Canada
| | - Samantha A Myers
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario M5G 1N8, Canada
- McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
| | - Samantha Yee
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario M5G 1N8, Canada
| | - Clifford L Librach
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario M5G 1N8, Canada
- Department of Obstetrics and Gynecology, University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S, Canada
- Department of Physiology, University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S, Canada
- Institute of Medical Science, University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S, Canada
- Department of Obstetrics and Reproductive Endocrinology, Sunnybrook Health Sciences Centre; 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada
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14
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Abstract
Hormonal therapy and gender-affirming surgeries in transgender people have known deleterious impacts on future fertility using one's own gametes. This review focuses on fertility preservation, including the effects of medical hormone treatment on fertility, available and experimental options of fertility preservation in transgender adults, including sperm cryopreservation for transwomen and oocyte cryopreservation for transmen, and options for prepubertal transgender adolescents, including testicular and ovarian tissue cryopreservation. Transgender patients continue to face barriers and receive infrequent counseling regarding fertility preservation. Physicians should ideally counsel and discuss fertility preservation options before transgender patients undergo hormone therapy of gender-affirmation surgery.
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Affiliation(s)
- Michael F Neblett
- Department of Gynecology and Obstetrics, Emory University, Emory University School of Medicine, Glenn Building, 4th Floor-412 B, 69 Jesse Hill Jr. Drive Southeast, Atlanta, GA 30303, USA
| | - Heather S Hipp
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, 550 Peachtree Street, Suite 1800, Atlanta, GA 30308, USA.
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15
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Mattawanon N, Spencer JB, Schirmer DA, Tangpricha V. Fertility preservation options in transgender people: A review. Rev Endocr Metab Disord 2018; 19:231-242. [PMID: 30219984 DOI: 10.1007/s11154-018-9462-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Gender affirming procedures adversely affect the reproductive potential of transgender people. Thus, fertility preservation options should be discussed with all transpeople before medical and surgical transition. In transwomen, semen cryopreservation is typically straightforward and widely available at fertility centers. The optimal number of vials frozen depends on their reproductive goals and treatment options, therefore a consultation with a fertility specialist is optimal. Experimental techniques including spermatogonium stem cells (SSC) and testicular tissue preservation are technologies currently under development in prepubertal individuals but are not yet clinically available. In transmen, embryo and/or oocyte cryopreservation is currently the best option for fertility preservation. Embryo cryopreservation requires fertilization of the transman's oocytes with a donor or partner's sperm prior to cryopreservation, but this limits his future options for fertilizing the eggs with another partner or donor. Oocyte cryopreservation offers transmen the opportunity to preserve their fertility without committing to a male partner or sperm donor at the time of cryopreservation. Both techniques however require at least a two-week treatment course, egg retrieval under sedation and considerable cost. Ovarian tissue cryopreservation is a promising experimental method that may be performed at the same time as gender affirming surgery but is offered in only a limited amount of centers worldwide. In select places, this method may be considered for prepubertal children, adolescents, and adults when ovarian stimulation is not possible. Novel methods such as in-vitro activation of primordial follicles, in vitro maturation of immature oocytes and artificial gametes are under development and may hold promise for the future.
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Affiliation(s)
- Natnita Mattawanon
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Jessica B Spencer
- Division of Reproductive Endocrinology, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - David A Schirmer
- Division of Reproductive Endocrinology, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
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16
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Migaou H, Youssef IBH, Boudokhane S, Kilani M, Jellad A, Frih ZBS. [Sexual disorders among spinal cord injury patients]. Prog Urol 2018; 28:980-986. [PMID: 30042073 DOI: 10.1016/j.purol.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/02/2018] [Accepted: 06/06/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Spinal cord injury (SCI) can alter to varying degrees patients' sexuality. The goals of this study were to evaluate sexual dysfunctions (SD) among a sample of Tunisian patients with SCI and to determine the associated factors. METHODS A cross-sectional descriptive study was conducted on a sample of 30 patients with SCI. Sexuality was evaluated by : Male Sexual Quotient (MSQ) and Sexual Health Inventory for Men (SHIM). Other parameters were collected : sociodemographic, clinical, functional capacity, psychological profile and quality of life (QoL) (Short-Form 36 SF36). RESULTS The mean age was 41±9.6 years (23-56). The frequency of SD in this study was 69.2 %. The most affected items in the MSQ (76 %) were erection, orgasm, seduction and performance. The SD were associated with alteration of SF36 domains. We noted positive correlations on the one hand between the MSQ score and the role physical (RP) and general health (GH) sub scores of SF36 and on the other hand between the SHIM and the sub scores RP, mental and physical component score (MCS and PCS). The MSQ score was negatively correlated with the HAD score. No other associations were noted. CONCLUSION Our study showed a high frequency of SD in SCI patients including Tunisians. SD were mainly associated with impaired QOL and the anxio-depressive profile. The absence of other associations could be explained mainly by the peculiarity of our culture which still considers sexuality and SD as a taboo and secondary subject.
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Affiliation(s)
- H Migaou
- Service de rééducation fonctionnelle, faculté de médecine de Monastir, centre hospitalo-universitaire Fattouma Bourguiba de Monastir, avenue 1-Juin, 5000 Monastir, Tunisie.
| | - I B H Youssef
- Unité de rééducation fonctionnelle, hôpital régional Haj Ali Souaa, avenue Habib Bourguiba, 5070 Ksar Hellal, Tunisie.
| | - S Boudokhane
- Service de rééducation fonctionnelle, faculté de médecine de Monastir, centre hospitalo-universitaire Fattouma Bourguiba de Monastir, avenue 1-Juin, 5000 Monastir, Tunisie.
| | - M Kilani
- Service de neurochirurgie, faculté de médecine de Monastir, centre hospitalo-universitaire Fattouma Bourguiba de Monastir, avenue 1-Juin, 5000 Monastir, Tunisie.
| | - A Jellad
- Service de rééducation fonctionnelle, faculté de médecine de Monastir, centre hospitalo-universitaire Fattouma Bourguiba de Monastir, avenue 1-Juin, 5000 Monastir, Tunisie.
| | - Z B S Frih
- Service de rééducation fonctionnelle, faculté de médecine de Monastir, centre hospitalo-universitaire Fattouma Bourguiba de Monastir, avenue 1-Juin, 5000 Monastir, Tunisie.
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17
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Abstract
PURPOSE OF REVIEW Men with spinal cord injury (SCI) commonly suffer from erectile dysfunction and ejaculatory dysfunction. The literature regarding the causes and treatment of these two important problems was reviewed. RECENT FINDINGS Many of the erectile dysfunction treatments applied to able bodied individuals are also useful in the SCI population, although there are differences in the goals and results of treatment. Ejaculatory dysfunction can be treated with either penile vibratory stimulation or electroejaculation with high success rates. Pregnancies are possible, but poor quality sperm quality in male SCI patients leads to pregnancy rates lower than is observed in the able-bodied population. Although effective treatments are available for erectile and ejaculatory dysfunction in men with SCIs, many challenges remain in optimizing the treatment of these individuals.
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18
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Alexander MS, Aisen CM, Alexander SM, Aisen ML. Sexual concerns after Spinal Cord Injury: An update on management. NeuroRehabilitation 2018; 41:343-357. [PMID: 29036845 DOI: 10.3233/nre-172202] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Spinal Cord Injury (SCI) causes neurological impairment with resultant neurogenic sexual dysfunction which can compound preexisting psychological and medical sexual concerns. Understanding these concerns is important in managing the lifelong needs of persons with SCIs. OBJECTIVES To provide an overview of the impact of SCI on sexuality along with a framework for treatment of sexual concerns. To briefly review male infertility and its treatments and pregnancy in females after SCI. METHODS Interdisciplinary literature review and synthesis of information. RESULTS The average age at SCI is increased, thus persons with SCIs may have preexisting sexual concerns. Sexual activity and satisfaction are decreased after SCI. Psychogenic sexual arousal is related to remaining sensation in the T11-L2 dermatomes. Orgasm occurs in approximately 50% of persons with SCIs with all injuries except subjects with complete lower motor neuron (LMN) injuries affecting the lowest sacral segments A structured approach to treatment including assessing preinjury function, determining the impact of injury, education, assessing and treating iatrogenic sexual dysfunction and treatment of concomitant problems is recommended. Basic and advanced methods to improve sexual arousal and orgasm are discussed and treatment of anejaculation and issues associated with pregnancy and SCI are reviewed. CONCLUSIONS Sexual satisfaction is impaired after SCI; however, education and new therapies can improve responsiveness. Future research is warranted to improve sexual function and fertility potential in persons with SCIs.
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Affiliation(s)
- Marcalee Sipski Alexander
- Birmingham VA Medical Center, Birmingham, AL, USA.,Department of PMR University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.,Department of PMR Harvard School of Medicine, Boston, MA, USA
| | - Carrie Mlynarczyk Aisen
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | - Mindy Lipson Aisen
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA.,Department of Neurology, University of Southern California, Los Angeles, CA, USA
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19
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Bazrafkan M, Nikmehr B, Shahverdi A, Hosseini SR, Hassani F, Poorhassan M, Mokhtari T, Abolhassani F, Choobineh H, Beyer C, Hassanzadeh G. Lipid Peroxidation and Its Role in the Expression of NLRP1a and NLRP3 Genes in Testicular Tissue of Male Rats: a Model of Spinal Cord Injury. IRANIAN BIOMEDICAL JOURNAL 2018; 22:151-9. [PMID: 29034676 PMCID: PMC5889500 DOI: 10.22034/ibj.22.3.151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: The majority of male patients with spinal cord injury (SCI) suffer from infertility. Nucleotide-binding oligomerization domain-like receptors NOD-like receptors (NLRs) are a kind of receptors that corporate in the inflammasome complex. Recent studies have introduced the inflammasome as the responsible agent for secreting cytokines in semen. Reactive oxygen species (ROS) is one of the elements that trigger inflammasome activation. Genital infections in SCI can lead to ROS generation. We investigated the relation between lipid peroxidation and inflammasome complex activity in testicular tissue of SCI rats. Methods: Adult male rats (n=20), weighting 200-250 g, were included and divided into four groups: three experimental groups, including SCI1, SCI3, and SCI7, i.e. the rats were subjected to SCI procedure and sacrificed after one, three, and seven days, respectively and a control group. We performed a moderate, midline spinal contusion injury at thoracic level 10. The animals were anesthetized, and testes were collected for measurement of gene expression by real-time PCR. Caudal parts of epididymis were collected for malondialdehyde (MDA) measurement. Results: No NLRP1a mRNA overexpression was seen in the testes of control and SCI groups. After seven days from SCI surgery, NLRP3 mRNA expression was significantly increased in SCI7 animals (p ≤ 0.05). There was a significant difference in MDA level in SCI7 versus control group, as well as SCI1 and SCI3 animals (p ≤ 0.05). Conclusion: NLRP3 overexpression occurs due to the increased ROS production in testis tissue of SCI rats
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Affiliation(s)
- Mahshid Bazrafkan
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Banafsheh Nikmehr
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Seyed Reza Hosseini
- Department of Urology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hassani
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Department of Embryology, Royan Institiute, Tehran, Iran
| | - Mahnaz Poorhassan
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahmineh Mokhtari
- Department of Anatomy, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran.,Research center of nervous system stem cells, Department of Anatomy, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Farid Abolhassani
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Choobineh
- School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Cordian Beyer
- Institute of Neuroanatomy, RWTH Aachen University, Aachen, Germany
| | - Gholamreza Hassanzadeh
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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20
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Choobineh H, Kazemi M, Sadighi Gilani MA, Heydari T, Shokri S, Bazrafkan M, Hassanzadeh G. Testosterone Reduces Spinal Cord Injury-Induced Effects on Male Reproduction by Preventing CADM1 Defect. CELL JOURNAL 2018; 20:138-149. [PMID: 29633590 PMCID: PMC5893284 DOI: 10.22074/cellj.2018.5003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 06/28/2017] [Indexed: 02/05/2023]
Abstract
Objective This study evaluated the effects of exogenous testosterone molecule-1 (CADM1) pathological defect during early
and chronic periods of spinal cord injury (SCI).
Materials and Methods In this experimental study, testosterone was administered immediately or after one week of SCI
induction. Along with quantification of CADM1 gene expression and its immunoreactivity, we evaluated sperm parameters and
serum testosterone level post-SCI.
Results Different grades of abnormalities in sperm parameters and testis architecture were observed along with
significant reductions in the level of CADM1 expression and its immunoreactivity in the seminiferous tubules of both
acute and chronic SCI groups. Exogenous testosterone, by compensating the serum testosterone level. reduced
the percentage of apoptotic and both short head and abnormal sperm froms in the caudal epididymis. Importantly,
the beneficial effects of immediate administration of testosterone were prominent. Increases in the level of CADM1
transcription and its immunoreactivity in the testis of SCI mice treated with testosterone were accompanied by
improvement of sperm motility as well as testicular Johnsen’s and Miller’s criteria.
Conclusion Since immediate testosterone treatment improved the immunoreactivity and transcription level of CADM1,
the observed beneficial effect of exogenouse testosterone can be attributed to its effect on CADM1 dynamics.
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Affiliation(s)
- Hamid Choobineh
- School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.,Zeoonosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Kazemi
- Department of Anatomy, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Tahereh Heydari
- Department of Biology, Islamic Azad University, Parand Branch, Iran
| | - Saeed Shokri
- Department of Anatomy, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mahshid Bazrafkan
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Hassanzadeh
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Electronicaddress:
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21
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Ge L, Wei LH, Du CQ, Song GH, Xue YZ, Shi HS, Yang M, Yin XX, Li RT, Wang XE, Wang Z, Song WG. Hydrogen-rich saline attenuates spinal cord hemisection-induced testicular injury in rats. Oncotarget 2018; 8:42314-42331. [PMID: 28404953 PMCID: PMC5522069 DOI: 10.18632/oncotarget.15876] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 01/27/2017] [Indexed: 12/27/2022] Open
Abstract
To study how hydrogen-rich saline (HS) promotes the recovery of testicular biological function in a hemi-sectioned spinal cord injury (hSCI) rat model, a right hemisection was performed at the T11–T12 of the spinal cord in Wistar rats. Animals were divided into four groups: normal group; vehicle group: sham-operated rats administered saline; hSCI group: subjected to hSCI and administered saline; HRST group: subjected to hSCI and administered HS. Hind limb neurological function, testis index, testicular morphology, mean seminiferous tubular diameter (MSTD) and seminiferous epithelial thickness (MSET), the expression of heme oxygenase-1 (HO-1), mitofusin-2 (MFN-2), and high-mobility group box 1 (HMGB-1), cell ultrastructure, and apoptosis of spermatogenic cells were studied. The results indicated that hSCI significantly decreased the hind limb neurological function, testis index, MSTD, and MSET, and induced severe testicular morphological injury. The MFN-2 level was decreased, and HO-1 and HMGB-1 were overexpressed in testicular tissues. In addition, hSCI accelerated the apoptosis of spermatogenic cells and the ultrastructural damage of cells in the hypophysis and testis. After HS administration, all these parameters were considerably improved, and the characteristics of hSCI testes were similar to those of normal control testes. Taken together, HS administration can promote the recovery of testicular biological function by anti-oxidative, anti-inflammatory, and anti-apoptotic action. More importantly, HS can inhibit the hSCI-induced ultrastructural changes in gonadotrophs, ameliorate the abnormal regulation of the hypothalamic-pituitary-testis axis, and thereby promote the recovery of testicular injury. HS administration also inhibited the hSCI-induced ultrastructural changes in testicular spermatogenic cells, Sertoli cells and interstitial cells.
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Affiliation(s)
- Li Ge
- Department of Histology and Embryology, Taishan Medical University, Tai-an City, PR China
| | - Li-Hua Wei
- Department of Histology and Embryology, Taishan Medical University, Tai-an City, PR China
| | - Chang-Qing Du
- Department of Histology and Embryology, Taishan Medical University, Tai-an City, PR China
| | - Guo-Hua Song
- Key Laboratory of Atherosclerosis in Universities of Shandong, Taishan Medical University, Institute of Atherosclerosis, Taishan Medical University, Tai-an City, PR China
| | - Ya-Zhuo Xue
- Department of Basic Nursing Teaching, Taishan Medical University, Tai-an City, PR China
| | - Hao-Shen Shi
- Department of Clinical Medicine, Taishan Medical University, Tai-an City, PR China
| | - Ming Yang
- Department of Clinical Medicine, Taishan Medical University, Tai-an City, PR China
| | - Xin-Xin Yin
- Department of Clinical Medicine, Taishan Medical University, Tai-an City, PR China
| | - Run-Ting Li
- Department of Clinical Medicine, Taishan Medical University, Tai-an City, PR China
| | - Xue-Er Wang
- Department of Physiology, Shandong University School of Medicine, Jinan, Shandong, PR China
| | - Zhen Wang
- Department of Physiology, Shandong University School of Medicine, Jinan, Shandong, PR China
| | - Wen-Gang Song
- Department of Medical Immunology, Taishan Medical University, Tai-an City, PR China
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22
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Kasum M, Orešković S, Kordić M, Čehić E, Hauptman D, Ejubović E, Lila A, Smolčić G. Improvement of Sexual and Reproductive Function in Men with Spinal Cord Lesion. Acta Clin Croat 2018; 57:149-156. [PMID: 30256024 PMCID: PMC6400349 DOI: 10.20471/acc.2018.57.01.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
SUMMARY – The aim of the review is to establish sexual and reproductive functions in men with spinal cord lesion (SCL). Many sexual and reproductive dysfunctions may be found in these patients including individual’s low self-esteem, delay of orgasm, erectile or ejaculatory disorder and abnormalities of semen, which are characterized by lower sperm motility or viability. Owing to improvements in physical medicine and rehabilitation, the focus has been shifted from keeping patients alive towards ensuring the quality of life and improvements of sexual dysfunctions and later reproduction. Erectile dysfunction can be treated by using phosphodiesterase-5 inhibitors, intracavernosal injections, vacuum devices and penile prostheses. Semen can be retrieved from anejaculatory patients by medically assisted methods utilizing penile vibratory stimulation, electroejaculation, prostate massage, or surgically. Although there is low chance for pregnancy in natural way in most of SCL patients, fatherhood is possible through the introduction of assisted medical management. By use of various medical, technical and surgical procedures for sperm retrieval combined with assisted reproductive methods, high pregnancy rates have been reported comparable to those in able-bodied subfertile patients. Nevertheless, future studies are needed to improve semen quality and methods of assisted ejaculation in patients with SCL.
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Affiliation(s)
| | - Slavko Orešković
- University Department of Obstetrics and Gynecology, Zagreb University Hospital Centre, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Mario Kordić
- Department of Urology, Mostar University Clinical Hospital, Mostar, Bosnia and Herzegovina
| | - Ermin Čehić
- Department of Obstetrics and Gynecology, Zenica Cantonal Hospital, Zenica, Bosnia and Herzegovina
| | - Dinko Hauptman
- Department of Urology, Zagreb University Hospital Centre, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Emina Ejubović
- Department of Obstetrics and Gynecology, Zenica Cantonal Hospital, Zenica, Bosnia and Herzegovina
| | - Albert Lila
- Kosovo Occupational Health Institute, Giakove, Kosovo
| | - Gordana Smolčić
- University Department of Obstetrics and Gynecology, Zagreb University Hospital Centre, School of Medicine, University of Zagreb, Zagreb, Croatia
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23
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Ibrahim E, Brackett NL, Lynne CM. Advances in the management of infertility in men with spinal cord injury. Asian J Androl 2017; 18:382-90. [PMID: 27048781 PMCID: PMC4854086 DOI: 10.4103/1008-682x.178851] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Couples with a spinal cord injured male partner require assisted ejaculation techniques to collect semen that can then be further used in various assisted reproductive technology methods to achieve a pregnancy. The majority of men sustaining a spinal cord injury regardless of the cause or the level of injury cannot ejaculate during sexual intercourse. Only a small minority can ejaculate by masturbation. Penile vibratory stimulation and electroejaculation are the two most common methods used to retrieve sperm. Other techniques such as prostatic massage and the adjunct application of other medications can be used, but the results are inconsistent. Surgical sperm retrieval should be considered as a last resort if all other methods fail. Special attention must be paid to patients with T6 and rostral levels of injury due to the risk of autonomic dysreflexia resulting from stimulation below the level of injury. Bladder preparation should be performed before stimulation if retrograde ejaculation is anticipated. Erectile dysfunction is ubiquitous in the spinal cord injured population but is usually easily managed and does not pose a barrier to semen retrieval in these men. Semen analysis parameters of men with spinal cord injury are unique for this population regardless of the method of retrieval, generally presenting as normal sperm concentration but abnormally low sperm motility and viability. When sperm retrieval is desired in this population, emphasis should be placed on initially trying the simple methods of penile vibratory stimulation or electroejaculation before resorting to more advanced and invasive surgical procedures.
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Affiliation(s)
| | - Nancy L Brackett
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL; Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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24
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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.
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Affiliation(s)
- Ermin Čehić
- a Human Reproduction Unit, Cantonal Hospital Zenica , Zenica , Bosnia and Herzegovina
| | - Miro Kasum
- b Department of Obstetrics and Gynaecology , School of Medicine, University Hospital Centre Zagreb, University of Zagreb , Zagreb , Croatia , and
| | - Velimir Šimunić
- c Human Reproduction Unit, Polyclinic IVF , Zagreb , Croatia
| | - Slavko Orešković
- b Department of Obstetrics and Gynaecology , School of Medicine, University Hospital Centre Zagreb, University of Zagreb , Zagreb , Croatia , and
| | - Goran Vujić
- b Department of Obstetrics and Gynaecology , School of Medicine, University Hospital Centre Zagreb, University of Zagreb , Zagreb , Croatia , and
| | - Franjo Grgić
- b Department of Obstetrics and Gynaecology , School of Medicine, University Hospital Centre Zagreb, University of Zagreb , Zagreb , Croatia , and
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25
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Ibrahim E, Lynne CM, Brackett NL. Male fertility following spinal cord injury: an update. Andrology 2015; 4:13-26. [PMID: 26536656 DOI: 10.1111/andr.12119] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/10/2015] [Accepted: 09/14/2015] [Indexed: 12/22/2022]
Abstract
Spinal cord injury (SCI) occurs most often in young men at the peak of their reproductive health. The majority of men with SCI cannot father children naturally. Three major complications contribute to infertility in men with SCI: erectile dysfunction, ejaculatory dysfunction, and abnormal semen quality. Erectile dysfunction can be managed by regimens available to the general population, including oral administration of phosphodiesterase-5 (PDE-5) inhibitors, intracavernosal injections, vacuum devices, and penile prostheses. Semen may be obtained from anejaculatory men with SCI via the medically assisted ejaculation methods of penile vibratory stimulation (PVS) or electroejaculation (EEJ). Sperm retrieval is also possible via prostate massage or surgical sperm retrieval. Most men with SCI have abnormal semen quality characterized by normal sperm concentrations but abnormally low sperm motility and viability. Accessory gland dysfunction has been proposed as the cause of these abnormalities. Leukocytospermia is evident in most SCI patients. Additionally, elevated concentrations of pro-inflammatory cytokines and elevated concentrations of inflammasome components are found in their semen. Neutralization of these constituents has resulted in improved sperm motility. There is a recent and alarming trend in the management of infertility in couples with SCI male partners. Although many men with SCI have sufficient motile sperm in their ejaculates for attempting intrauterine insemination (IUI) or even intravaginal insemination, surgical sperm retrieval is often introduced as the first and only sperm retrieval method for these couples. Surgical sperm retrieval commits the couple to the most advanced, expensive, and invasive method of assisted conception: in vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI). Couples should be informed of all options, including semen retrieval by PVS or EEJ. Intravaginal insemination or IUI should be considered when indicated.
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Affiliation(s)
- E Ibrahim
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - C M Lynne
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - N L Brackett
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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26
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Fode M, Ohl DA, Sønksen J. A step-wise approach to sperm retrieval in men with neurogenic anejaculation. Nat Rev Urol 2015; 12:607-16. [PMID: 26481575 DOI: 10.1038/nrurol.2015.241] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Normal fertility is dependent on intravaginal delivery of semen through ejaculation. This process is highly dependent on an intact ejaculatory reflex arc, which can be disrupted through any type of trauma or disease causing damage to the CNS and/or peripheral nerves. Neurogenic anejaculation is most commonly associated with spinal cord injury. This aetiology is especially relevant because most men with spinal cord injuries are injured at reproductive age. Assisted ejaculation in the form of penile vibratory stimulation is the first choice for sperm retrieval in such patients because it is noninvasive and inexpensive. In patients in whom vibratory stimulation fails, electroejaculation is almost always successful. When both methods of assisted ejaculation are unsuccessful, sperm retrieval by aspiration from either the vas deferens or the epididymis, or by testicular biopsy or surgery are reasonable options. In such cases the most inexpensive and least invasive methods should be considered first. The obtained semen can be used for intravaginal or intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection.
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Affiliation(s)
- Mikkel Fode
- Department of Urology, Roskilde Hospital, Koegevej 7-13, DK-4000 Roskilde, Denmark
| | - Dana A Ohl
- Department of Urology, University of Michigan, 1500 East Medical Center Drive, Box 0330, Ann Arbor, MI 48108, USA
| | - Jens Sønksen
- Department of Urology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
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27
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Abstract
Many aspects of fertility rely on intact neurologic function and thus neurologic diseases can result in infertility. While research into general female fertility and alterations in male semen quality is limited, we have an abundance of knowledge regarding ejaculatory dysfunction following nerve injury. Normal ejaculation is the result of coordinated reflex activity involving both the sympathetic and somatic nervous systems. Nerve injury can result in retrograde ejaculation, and anejaculation. With retrograde ejaculation, the ejaculate is propelled into the bladder instead of out through the urethra. In mild cases this condition can be reversed by sympathomimetic medications and, in more severe cases, sperm cells can be extracted from the bladder following ejaculation. With anejaculation, the ejaculatory reflex is not activated by normal sexual stimulation. In such cases, the first choice of treatment is assisted ejaculation, preferably by penile vibratory stimulation. If vibratory stimulation is unsuccessful, then ejaculation can almost always be induced by electroejaculation. In cases where assisted ejaculation fails, sperm can be retrieved surgically from either the epididymis or from the testis. Once viable sperm cells have been obtained, these are used in assisted reproductive techniques, including intravaginal insemination, intrauterine insemination, and in vitro fertilization/intracytoplasmic sperm injection.
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Krebs J, Göcking K, Kissling-Niggli M, Pannek J. Cross-sectional study of the sperm quality in semen samples from spinal cord injured men after long-term cryopreservation. Andrology 2015; 3:213-9. [DOI: 10.1111/andr.12017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/06/2015] [Accepted: 01/15/2015] [Indexed: 11/27/2022]
Affiliation(s)
- J. Krebs
- Clinical Trial Unit; Swiss Paraplegic Centre; Nottwil Switzerland
| | - K. Göcking
- Neurourology; Swiss Paraplegic Centre; Nottwil Switzerland
| | | | - J. Pannek
- Neurourology; Swiss Paraplegic Centre; Nottwil Switzerland
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Krebs J, Göcking K, Pannek J. Testicular resistive index determined by Doppler ultrasonography in men with spinal cord injury - a case series. Andrologia 2014; 47:811-5. [PMID: 25228165 DOI: 10.1111/and.12334] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2014] [Indexed: 11/30/2022] Open
Abstract
In this case series, the testicular resistive index was determined in men with spinal cord injury. In ten men participating in our fertility programme, the peak systolic and end-diastolic velocity of centripetal testicular arteries was measured in triplicates by Doppler ultrasonography to calculate the testicular resistive index. Furthermore, the right and left testicular volume was determined by ultrasonography, blood samples were obtained for hormonal evaluation, and sperm analysis was performed according to the WHO guidelines. The median testicular resistive index measured 0.69 and was significantly (P < 0.001) greater than the reported cut-off value of 0.6. The spermiograms were characterised by normal sperm count but decreased sperm motility and plasma membrane integrity. The median right and left testicular volume was significantly (P < 0.01) smaller compared to the volumes measured in able-bodied adult males without scrotal pathology and measured 8.4 ml and 7.2 ml respectively. There was a significant (P = 0.005) correlation (rs = 0.81) between testicular resistive index and sperm concentration. However, no correlations were observed between testicular resistive index and other variables. The testicular resistive index in men with spinal cord injury was significantly greater than 0.6. Measuring the testicular resistive index may represent a useful additional parameter in the assessment of infertility in spinal cord-injured men.
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Affiliation(s)
- J Krebs
- Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - K Göcking
- Neurourology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - J Pannek
- Neurourology, Swiss Paraplegic Centre, Nottwil, Switzerland
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Ibrahim E, Castle SM, Aballa TC, Keane RW, de Rivero Vaccari JP, Lynne CM, Brackett NL. Neutralization of ASC improves sperm motility in men with spinal cord injury. Hum Reprod 2014; 29:2368-73. [PMID: 25205754 DOI: 10.1093/humrep/deu230] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does neutralization of apoptosis-associated speck-like protein containing a caspase activation and recruitment domain (ASC) improve sperm motility in men with spinal cord injury (SCI)? SUMMARY ANSWER Neutralization of ASC improves sperm motility in men with SCI. WHAT IS KNOWN ALREADY Semen of men with SCI contains normal sperm concentrations but abnormally low sperm motility. Inflammatory cytokines, activated via the inflammasome complex, are contributory. A key component of the inflammasome is ASC. STUDY DESIGN, SIZE, DURATION This prospective study included semen samples collected from 32 men with SCI. PARTICIPANTS/MATERIALS, SETTING, METHODS At a major university medical center, untreated semen was compared with semen treated with anti-ASC polyclonal antibody. Semen treated with IgG was used as a control. MAIN RESULTS AND THE ROLE OF CHANCE Addition of anti-ASC polyclonal antibody to semen significantly increased mean sperm motility from 11.5% (95% CI, 6.3-16.7) to 18.3% (95% CI, 11.8-24.8). Improvements were most pronounced in the subgroup whose starting motility ranged between 6 and 40%. In this subgroup, the mean sperm motility improved from 13.3% (95% CI, 9.3-17.3) to 23.9% (95% CI, 14.7-23.0). Sperm motility did not improve after treatment with IgG. LIMITATIONS, REASONS FOR CAUTION This study is limited by the small sample size as this is a rare population. WIDER IMPLICATIONS OF THE FINDINGS Blockade of the inflammasome via treatment with anti-ASC improved sperm motility in men with SCI. In doing so, this treatment significantly increased their total motile sperm count. This is the first study to demonstrate that interference with the inflammasome improves sperm motility in men with SCI. This treatment has potential as a therapeutic intervention. STUDY FUNDING/COMPETING INTERESTS This study was funded by the Craig H. Neilsen Foundation, Grant # 224598, the University of Miami Miller School of Medicine and the Miami Project to Cure Paralysis, Miami, FL, USA. R.W.K. and J.P.d.R.V. hold a patent for the treatment of inflammation after central nervous system injury using antibodies against inflammasome proteins. The other authors have no conflicts of interest to declare.
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Affiliation(s)
- E Ibrahim
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - S M Castle
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - T C Aballa
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - R W Keane
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - J P de Rivero Vaccari
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - C M Lynne
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - N L Brackett
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
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Abstract
Ejaculatory dysfunction may occur after many different disorders ranging from traumatic spinal cord injury to diabetes mellitus. With an understanding of the many facets and nuances of the ejaculatory apparatus, both anatomic and neurologic, the well-versed clinician can proceed along a safe, efficient, and appropriate treatment algorithm to help affected men and their partners achieve parenthood.
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Affiliation(s)
- Elizabeth Phillips
- Division of Urology, Boston University School of Medicine, Shapiro Center, Suite 3B, 715 Albany Street, Boston, MA 02118, USA
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Karsenty G, Bernuz B, Metzler-Guillemain C, Grillo JM, Saïas-Magnan J, Rigot JM, Perrin J. Should sperm be cryopreserved after spinal cord injury? Basic Clin Androl 2013. [DOI: 10.1186/2051-4190-23-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
In spinal cord injured (SCI) patients, three main factors may cause infertility: erectile dysfunction, ejaculatory dysfunction and impaired semen quality. This letter aims to discuss how we can manage SCI patients’ fertility in accordance with patient-centred care. For such SCI patients aged 20 to 40, having children represents hope for the future. Furthermore, it is a way to rebuild a life after the spinal injury and must be seen as an important part of the rehabilitation program. We suggest that sperm cryopreservation may contribute to patient-centred care management of SCI patients’ fertility, although there is no scientific evidence that cryopreservation will improve fertility outcome after SCI. Indeed, sperm cryopreservation is an affordable and simple technique in specialised centres with trained staff. Here, a protocol to manage SCI patients’ fertility is discussed: we propose PVS for sperm banking to all SCI patients after the phase of spinal shock during the rehabilitation program. If live sperm are retrieved, they are frozen and stored; however, if no live sperm are retrieved, electroejaculation and/or surgical sperm extraction are proposed only for patients who desire biological fatherhood. Prospective studies on the evolution of semen parameters, ejaculatory dysfunction, post-infectious obstructions and spermatogenesis impairment in chronic SCI patients are urgently needed to provide robust data for the evidence-based management of SCI patients’ fertility. Even if use rates are expected to be low, sperm banking may be a simple and affordable preventative measure for selected male SCI patients.
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Chéhensse C, Bahrami S, Denys P, Clément P, Bernabé J, Giuliano F. The spinal control of ejaculation revisited: a systematic review and meta-analysis of anejaculation in spinal cord injured patients. Hum Reprod Update 2013; 19:507-26. [DOI: 10.1093/humupd/dmt029] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Testicular sperm retrieval and intra cytoplasmic sperm injection provide favorable outcome in spinal cord injury patients, failing conservative reproductive treatment. Spinal Cord 2013; 51:642-4. [PMID: 23689394 DOI: 10.1038/sc.2013.44] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 03/21/2013] [Accepted: 04/04/2013] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective cohort analysis. OBJECTIVES The objective of this study was to determine the in vitro fertilization (IVF) outcome after testicular sperm extraction (TESE) in a group of spinal cord injury (SCI) male patients not compatible with conservative fertility treatment. SETTING University-affiliated medical center. METHODS Thirty two SCI patients (C2 to L2) were referred to IVF after repeated trials of electroejaculation (EEJ) or penile vibratory stimulation (PVS), and full andrological evaluation. Testicular sperm aspiration (TESA) was the method of choice for sperm extraction. Open TESE was performed only after a negative TESA attempt. Clinical pregnancy and live birth rates were determined. RESULTS A total of 106 testicular procedures were performed. Sperm was found in 95 cycles (89.6%). The average metaphase II (MII) oocyte number was 11.0±4.2, an average of 5.1±2.3 oocytes became normally fertilized after Intra Cytoplasmic Sperm Injection (ICSI) (fertilization rate 57.1%). On average, 2.7±1.2 embryos were replaced. The clinical pregnancy rate was 32/106 (30.2%) per cycle and 19/32 (59.3%) per couple. Live birth rate was 62.5% (20/32). CONCLUSIONS TESA/E and IVF can provide excellent prognosis for SCI patients that cannot be treated by EEJ or PVS.
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Involvement of the inflammasome in abnormal semen quality of men with spinal cord injury. Fertil Steril 2013; 99:118-124.e2. [DOI: 10.1016/j.fertnstert.2012.09.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 07/05/2012] [Accepted: 09/04/2012] [Indexed: 01/22/2023]
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Falavigna A, Finger G, Souza OED, Pasqualotto FF. Spinal cord injury and male infertility: a review. COLUNA/COLUMNA 2012. [DOI: 10.1590/s1808-18512012000400015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spinal cord injuries remain an important factor of morbimortality in current society, involving mainly males from adolescence to adulthood. Among the sequelae caused by spinal cord injuries, the impairment of the sexual system is highly relevant since it affects the quality of sexual life and paternity. Infertility is secondary to multiple events such as erectile dysfunction, anejaculation, seminal biochemical modification and morphology of spermatozoa. Current therapies for the infertile spinal cord injured patient focus on the ejaculation stimulus followed by intrauterine insemination, leaving seminal low quality as the major factor of infertility in these patients. In this scenario, therapy with hyperbaric oxygenation, which is still being studied, represents an alternative treatment since it focuses on the central nervous system injured by the trauma and the testicular tissue in order to decrease spinal damage and to preserve the physiological regulation of the urogenital system as a form of avoiding infertility.
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Brackett NL. Infertility in men with spinal cord injury: research and treatment. SCIENTIFICA 2012; 2012:578257. [PMID: 24278717 PMCID: PMC3820516 DOI: 10.6064/2012/578257] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 11/08/2012] [Indexed: 06/02/2023]
Abstract
Spinal cord injury (SCI) occurs most often to young men. Following SCI, most men are infertile due to a combination of erectile dysfunction, ejaculatory dysfunction and semen abnormalities. Erectile dysfunction may be treated by the same therapies that are used in the general population. Similarly, the same treatments that are effective to assist conception in couples with non-SCI male factor patients are effective in assisting conception in SCI male-factor patients. The most apparent differences in male-factor symptoms between SCI and non-SCI patients are the high occurrences of anejaculation and atypical semen profiles in men with SCI. Methods available to assist ejaculation in men with SCI include penile vibratory stimulation and EEJ. Use of surgical sperm retrieval as the first line of treatment for anejaculation in men with SCI is controversial. Most men with SCI have a unique semen profile characterized by normal sperm concentration, but abnormally low sperm motility. Toxic substances in the semen contribute to this problem. Despite impaired sperm parameters, pregnancy outcomes using sperm from men with SCI are similar to pregnancy outcomes using sperm from non-SCI men. Future studies should focus on improving natural ejaculation and improving semen quality in these men.
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Affiliation(s)
- Nancy L. Brackett
- Lois Pope Life Center, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Room 2-17, 1095 NW 14th Terrace, Miami, FL 33136, USA
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38
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Abstract
Ejaculatory dysfunction is a highly prevalent clinical condition that may be classified along a continuum that ranges from premature ejaculation (PE), through retarded or delayed ejaculation (DE), to complete anejaculation (AE). Retrograde ejaculation (RE) represents a distinct entity in which ejaculate is expelled either partially or completely into the bladder. While DE and PE are significant sources of sexual dissatisfaction among men and their partners, patients with these disorders retain normal fertility in most cases. Conversely, men with AE and RE are unable to deliver sperm into the female genital tract and are therefore rendered subfertile. Therefore, in reviewing ejaculatory disorders as they relate to fertility, this paper will primarily focus on the diagnosis and management of AE and RE. Physiology, diagnostic strategies, pharmacological treatments, and procedural interventions relevant to AE and RE are discussed.
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Qiu Y, Wang LG, Zhang LH, Li J, Zhang AD, Zhang MH. Sperm chromosomal aneuploidy and DNA integrity of infertile men with anejaculation. J Assist Reprod Genet 2012; 29:185-94. [PMID: 22215471 DOI: 10.1007/s10815-011-9688-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Accepted: 11/30/2011] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To explore sperm chromosomal aneuploidy, sperm membrane and DNA integrity in infertile patients with anejaculation. METHODS Semen samples were collected from 18 infertile men with spinal cord injury (SCI) by penile vibratory stimulation (PVS) and from 14 psychogenic anejaculation (PA) patients by percutaneous vasal sperm aspiration (PVSA). These semen samples as well as samples from 16 donors were analyzed using the hypo-osmotic swelling (HOS) test, the sperm chromatin dispersion (SCD) test and multi-color fluorescence in situ hybridization (FISH) with probes specific for chromosomes 13, 18, 21, X and Y. RESULTS There were significant differences in the percentages of motile sperm, normal morphologic sperm and sperm DNA fragmentation between the infertile men with SCI and the control group (P < 0.05 and P < 0.01). The sperm motility was significantly greater in the PA-PVSA group than in the SCI-PVS group (P < 0.01). The number of round cells per mL of semen obtained from the 18 SCI patients by PVS was between 1 and 8 million. The rate of sperm DNA fragmentation in the SCI-PVS group was higher than that of the PA-PVSA group (P < 0.05). The aneuploidy rates for the SCI patients were 2.4-fold higher for chromosomes 13, 18 and 21 and 2.2-fold higher for chromosomes X and Y than for patients in the control group (P < 0.0001). CONCLUSIONS The semen quality is poorer, sperm DNA fragmentation and sperm chromosomal aneuploidies are seen at a higher rate for SCI patients compared to healthy, fertile and normospermic men. Whether the difference in yield is due to increased scrotal temperature, genitourinary infection, or other reasons requires further study.
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Affiliation(s)
- Yi Qiu
- Key Laboratory for Improving Birth Outcome Technique, Shandong Provincial Family Planning Institute of Science and Technology, Jinan, Shandong, China.
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Fode M, Krogh-Jespersen S, Brackett NL, Ohl DA, Lynne CM, Sønksen J. Male sexual dysfunction and infertility associated with neurological disorders. Asian J Androl 2011; 14:61-8. [PMID: 22138899 DOI: 10.1038/aja.2011.70] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Normal sexual and reproductive functions depend largely on neurological mechanisms. Neurological defects in men can cause infertility through erectile dysfunction, ejaculatory dysfunction and semen abnormalities. Among the major conditions contributing to these symptoms are pelvic and retroperitoneal surgery, diabetes, congenital spinal abnormalities, multiple sclerosis and spinal cord injury. Erectile dysfunction can be managed by an increasingly invasive range of treatments including medications, injection therapy and the surgical insertion of a penile implant. Retrograde ejaculation is managed by medications to reverse the condition in mild cases and in bladder harvest of semen after ejaculation in more severe cases. Anejaculation might also be managed by medication in mild cases while assisted ejaculatory techniques including penile vibratory stimulation and electroejaculation are used in more severe cases. If these measures fail, surgical sperm retrieval can be attempted. Ejaculation with penile vibratory stimulation can be done by some spinal cord injured men and their partners at home, followed by in-home insemination if circumstances and sperm quality are adequate. The other options always require assisted reproductive techniques including intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection. The method of choice depends largely on the number of motile sperm in the ejaculate.
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Affiliation(s)
- Mikkel Fode
- Department of Urology, Herlev Hospital, University of Copenhagen, Denmark
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41
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Sønksen J, Fode M, Löchner-Ernst D, Ohl DA. Vibratory ejaculation in 140 spinal cord injured men and home insemination of their partners. Spinal Cord 2011; 50:63-6. [DOI: 10.1038/sc.2011.101] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kathiresan AS, Ibrahim E, Aballa TC, Attia GR, Ory SJ, Hoffman DI, Maxson WS, Barrionuevo MJ, Lynne CM, Brackett NL. Comparison of in vitro fertilization/intracytoplasmic sperm injection outcomes in male factor infertility patients with and without spinal cord injuries. Fertil Steril 2011; 96:562-6. [DOI: 10.1016/j.fertnstert.2011.06.078] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 06/20/2011] [Accepted: 06/27/2011] [Indexed: 11/28/2022]
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43
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Pregnancy outcomes by intravaginal and intrauterine insemination in 82 couples with male factor infertility due to spinal cord injuries. Fertil Steril 2011; 96:328-31. [DOI: 10.1016/j.fertnstert.2011.05.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 05/03/2011] [Accepted: 05/05/2011] [Indexed: 11/20/2022]
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Roberts M, Jarvi K. Steps in the investigation and management of low semen volume in the infertile man. Can Urol Assoc J 2011; 3:479-85. [PMID: 20019978 DOI: 10.5489/cuaj.1180] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
An adequate semen volume of ejaculate fluid is required to transport sperm into the female reproductive tract and allow for fertilization of the oocyte. Thus, seminal fluid volume is an important part of the semen analysis done to investigate male infertility. In this article, we review the anatomy and physiology of ejaculation, the various etiologies of low-volume ejaculation (artifactual, structural, functional). We then present a comprehensive algorithm for the evaluation, diagnosis and treatment of the infertile man presenting with low semen volume.
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Perrin J, Saïas-Magnan J, Thiry-Escudié I, Gamerre M, Serment G, Grillo JM, Guillemain C, Karsenty G. Le blessé médullaire : quel sperme et quelle prise en charge en Assistance médicale à la procréation ? ACTA ACUST UNITED AC 2010; 38:532-5. [DOI: 10.1016/j.gyobfe.2010.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 07/05/2010] [Indexed: 11/30/2022]
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The choice of assisted ejaculation method is relevant for the diagnosis of azoospermia in men with spinal cord injuries. Spinal Cord 2010; 49:55-9. [PMID: 20680020 DOI: 10.1038/sc.2010.91] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective analysis of research data collected over >18 years at our center. OBJECTIVES Examine results of repeated semen retrievals in men with spinal cord injury (SCI) who were initially found to be azoospermic. SETTING Major university medical center. METHODS Three different groups were analyzed in this study. Group 1 (n = 15) consisted of patients who were found to be azoospermic after the first ejaculation obtained by penile vibratory stimulation (PVS) and who had subsequent ejaculates obtained by PVS. Group 2 (n = 8) consisted of patients who were found to be azoospermic after the first ejaculation obtained by PVS and who had subsequent ejaculates obtained by electroejaculation (EEJ). Group 3 (n = 18) consisted of patients who were found to be azoospermic after the first ejaculation obtained by EEJ and who had subsequent ejaculates obtained by EEJ. RESULTS In group 1 (PVS-PVS), the second ejaculate contained sperm in none of the 15 patients. In group 2 (PVS-EEJ), the second ejaculate contained sperm in three of eight patients. In group 3 (EEJ-EEJ), the second EEJ resulted in semen with sperm in 6 of 18 patients. In the 388 study subjects, the overall prevalence of azoospermia was 7.0%. CONCLUSION In a study of a large group of subjects with SCI, the vast majority had normal sperm concentrations. In the minority who were azoospermic on their first ejaculate, and who were past the acute phase of injury, obtaining a second ejaculate by EEJ versus PVS may be a reasonable step before proceeding to surgical sperm retrieval.
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A Minority of Men With Spinal Cord Injury Have Normal Semen Quality—Can We Learn From Them? A Case-control Study. Urology 2010; 76:347-51. [DOI: 10.1016/j.urology.2009.11.063] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 10/29/2009] [Accepted: 11/13/2009] [Indexed: 11/23/2022]
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48
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Dimitriadis F, Karakitsios K, Tsounapi P, Tsambalas S, Loutradis D, Kanakas N, Watanabe NT, Saito M, Miyagawa I, Sofikitis N. Erectile function and male reproduction in men with spinal cord injury: a review. Andrologia 2010; 42:139-65. [DOI: 10.1111/j.1439-0272.2009.00969.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Brackett NL, Ibrahim E, Iremashvili V, Aballa TC, Lynne CM. Treatment for Ejaculatory Dysfunction in Men With Spinal Cord Injury: An 18-Year Single Center Experience. J Urol 2010; 183:2304-8. [DOI: 10.1016/j.juro.2010.02.018] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Nancy L. Brackett
- Miami Project to Cure Paralysis and Department of Urology (CML), University of Miami Miller School of Medicine, Miami, Florida
| | - Emad Ibrahim
- Miami Project to Cure Paralysis and Department of Urology (CML), University of Miami Miller School of Medicine, Miami, Florida
| | - Viacheslav Iremashvili
- Miami Project to Cure Paralysis and Department of Urology (CML), University of Miami Miller School of Medicine, Miami, Florida
| | - Teodoro C. Aballa
- Miami Project to Cure Paralysis and Department of Urology (CML), University of Miami Miller School of Medicine, Miami, Florida
| | - Charles M. Lynne
- Miami Project to Cure Paralysis and Department of Urology (CML), University of Miami Miller School of Medicine, Miami, Florida
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50
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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.
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