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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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Pavuluri H, Bakhtiary Z, Panner Selvam MK, Hellstrom WJG. Oxidative Stress-Associated Male Infertility: Current Diagnostic and Therapeutic Approaches. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1008. [PMID: 38929625 PMCID: PMC11205999 DOI: 10.3390/medicina60061008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/11/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
Infertility is a prevalent global issue affecting approximately 17.5% of adults, with sole male factor contributing to 20-30% of cases. Oxidative stress (OS) is a critical factor in male infertility, disrupting the balance between reactive oxygen species (ROS) and antioxidants. This imbalance detrimentally affects sperm function and viability, ultimately impairing fertility. OS also triggers molecular changes in sperm, including DNA damage, lipid peroxidation, and alterations in protein expression, further compromising sperm functionality and potential fertilization. Diagnostic tools discussed in this review offer insights into OS markers, antioxidant levels, and intracellular ROS concentrations. By accurately assessing these parameters, clinicians can diagnose male infertility more effectively and thus tailor treatment plans to individual patients. Additionally, this review explores various treatment options for males with OS-associated infertility, such as empirical drugs, antioxidants, nanoantioxidants, and lifestyle modifications. By addressing the root causes of male infertility and implementing targeted interventions, clinicians can optimize treatment outcomes and enhance the chances of conception for couples struggling with infertility.
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Affiliation(s)
| | | | | | - Wayne J. G. Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, USA; (H.P.); (Z.B.); (M.K.P.S.)
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3
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Wulf MJ, Tom VJ. Consequences of spinal cord injury on the sympathetic nervous system. Front Cell Neurosci 2023; 17:999253. [PMID: 36925966 PMCID: PMC10011113 DOI: 10.3389/fncel.2023.999253] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/09/2023] [Indexed: 03/06/2023] Open
Abstract
Spinal cord injury (SCI) damages multiple structures at the lesion site, including ascending, descending, and propriospinal axons; interrupting the conduction of information up and down the spinal cord. Additionally, axons associated with the autonomic nervous system that control involuntary physiological functions course through the spinal cord. Moreover, sympathetic, and parasympathetic preganglionic neurons reside in the spinal cord. Thus, depending on the level of an SCI, autonomic function can be greatly impacted by the trauma resulting in dysfunction of various organs. For example, SCI can lead to dysregulation of a variety of organs, such as the pineal gland, the heart and vasculature, lungs, spleen, kidneys, and bladder. Indeed, it is becoming more apparent that many disorders that negatively affect quality-of-life for SCI individuals have a basis in dysregulation of the sympathetic nervous system. Here, we will review how SCI impacts the sympathetic nervous system and how that negatively impacts target organs that receive sympathetic innervation. A deeper understanding of this may offer potential therapeutic insight into how to improve health and quality-of-life for those living with SCI.
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Affiliation(s)
| | - Veronica J. Tom
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States
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4
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Zizzo J, Gater DR, Hough S, Ibrahim E. Sexuality, Intimacy, and Reproductive Health after Spinal Cord Injury. J Pers Med 2022; 12:jpm12121985. [PMID: 36556205 PMCID: PMC9781084 DOI: 10.3390/jpm12121985] [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: 11/14/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/04/2022] Open
Abstract
Spinal cord injury (SCI) is a life-altering event often accompanied by a host of anxiety-provoking questions and concerns in the minds of affected individuals. Questions regarding the ability to resume sexual activity, partner's satisfaction as well as the ability to have biological children are just a few of the unknowns facing patients following the devastating reality that is SCI. As a result of advances in SCI research over the last few decades, providers now have the knowledge and tools to address many of these concerns in an evidence-based and patient-centered approach. SCI can impair multiple components involved in sexual function, including libido, achieving and maintaining an erection, ejaculation, and orgasm. Many safe and effective fertility treatments are available to couples affected by SCI. Finally, learning to redefine one's self-image, reinforce confidence and self-esteem, and feel comfortable communicating are equally as important as understanding functionality in regaining quality of life after SCI. Thus, this review aims to highlight the current state of SCI research relating to sexual function, reproductive health, and the search for meaning.
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Affiliation(s)
- John Zizzo
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - David R. Gater
- Department of Physical Medicine & Rehabilitation, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Sigmund Hough
- Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA 02215, USA
- Department of Psychiatry, Boston University School of Medicine, Boston University, Boston, MA 02118, USA
| | - Emad Ibrahim
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Correspondence:
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5
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Sharma R, Gupta S, Agarwal A, Henkel R, Finelli R, Parekh N, Saleh R, Arafa M, Ko E, Zini A, Tadros N, Shah R, Ambar RF, Elbardisi H, Sengupta P, Martinez M, Boitrelle F, Simopoulou M, Vogiatzi P, Gosalvez J, Kavoussi P, Kandil H, Palani A, Rodriguez Peña M, Rajmil O, Busetto GM, Anagnostopoulou C, Micic S, Alves MG, Rocco L, Mostafa T, Alvarez JG, Jindal S, Sallam HN, Maldonado Rosas I, Lewis SEM, AlSaid S, Altan M, Park HJ, Ramsay J, Parekattil S, Sabbaghian M, Tremellen K, Khalafalla K, Durairajanayagam D, Colpi GM. Relevance of Leukocytospermia and Semen Culture and Its True Place in Diagnosing and Treating Male Infertility. World J Mens Health 2022; 40:191-207. [PMID: 34169683 PMCID: PMC8987138 DOI: 10.5534/wjmh.210063] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/17/2021] [Accepted: 04/21/2021] [Indexed: 02/05/2023] Open
Abstract
The current WHO 2010 manual for human semen analysis defines leukocytospermia as the presence of peroxidase-positive leukocytes at a concentration >1×106/mL of semen. Granular leukocytes when activated are capable of generating high levels of reactive oxygen species in semen resulting in oxidative stress. Oxidative stress has been correlated with poor sperm quality, increased level of sperm DNA fragmentation and low fertility potential. The presence of leukocytes and pathogens in the semen may be a sign of infection and/or localized inflammatory response in the male genital tract and the accessory glands. Common uro-pathogens including Chlamydia trachomatis, Ureaplasma urealyticum, Neisseria gonorrhoeae, Mycoplasma hominis, and Escherichia coli can cause epididymitis, epididymo-orchitis, or prostatitis. The relationship between leukocytospermia and infection is unclear. Therefore, we describe the pathogens responsible for male genital tract infections and their association with leukocytospermia. The review also examines the diagnostic tests available to identify seminal leukocytes. The role of leukocytospermia in male infertility and its management is also discussed.
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Affiliation(s)
- Rakesh Sharma
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Sajal Gupta
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Neel Parekh
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mohamed Arafa
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Edmund Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Armand Zini
- Department of Surgery, McGill University, Montreal, Canada
| | - Nicholas Tadros
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Rafael F Ambar
- Department of Urology, Centro Universitario em Saude do ABC/Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Pallav Sengupta
- Department of Physiology, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom, Selangor, Malaysia
| | - Marlon Martinez
- Section of Urology, University of Santo Tomas Hospital, Manila, Philippines
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
- Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
| | - Mara Simopoulou
- Department of Physiology, School of Medicine, National & Kapodistrian University of Athens, Maroussi, Athens, Greece
| | - Paraskevi Vogiatzi
- Andromed Health & Reproduction, Fertility Diagnostics Laboratory, Maroussi, Greece
| | - Jaime Gosalvez
- Departamento de Biología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Parviz Kavoussi
- Austin Fertility and Reproductive Medicine/Westlake IVF, Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Ayad Palani
- Department of Biochemistry, College of Medicine, University of Garmian, Kalar, Iraq
| | - Marcelo Rodriguez Peña
- Departamento Docencia e Investigación, Hospital Militar Campo de Mayo, Universidad Barcelo, Buenos Aires, Argentina
| | - Osvaldo Rajmil
- Clinical and training Centre of the European Academy of Andrology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia Policlinico Riuniti of Foggia, Foggia, Italy
| | | | - Sava Micic
- Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
| | - Marco G Alves
- Department of Anatomy & Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Lucia Rocco
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies (DiSTABiF), University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Taymour Mostafa
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Juan G Alvarez
- Centro ANDROGEN, La Coruña, Spain
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Sunil Jindal
- Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
| | - Hassan N Sallam
- Department of Obstetrics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Israel Maldonado Rosas
- Centerf Technological Innovation, and Reproductive Medicine (CITMER), Mexico City, Mexico
| | - Sheena E M Lewis
- Examenlab Ltd., Weavers Court Business Park, Linfield Road, Belfast, Northern Ireland, UK
| | - Sami AlSaid
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Mesut Altan
- Department of Urology, Haceppete University, Ankara, Turkey
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | | | - Sijo Parekattil
- Avant Concierge Urology & University of Central Florida, Winter Garden, FL, USA
| | - Marjan Sabbaghian
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Kelton Tremellen
- Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Adelaide, South Australia
| | | | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
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Chalas C, Jilet L, Wolf JP, Drouineaud V, Abdoul H, Patrat C, Denys P, Giuliano F. Prospective analysis over time of semen parameters in spinal cord-injured patients: Results of a pilot study. Andrology 2021; 10:120-127. [PMID: 34347944 DOI: 10.1111/andr.13089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/20/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Spinal cord injury often results in erectile dysfunction and an ejaculation along with impaired semen parameters. Fertility is a major concern in spinal cord injury adult males and some fear that the delay post-spinal cord injury may negatively affect sperm quality. OBJECTIVES We aimed to (i) assess semen parameters over time in SCI patients according to age at spinal cord injury, time post-spinal cord injury, and the spinal cord injury level and completeness and (ii) measure markers in semen for inflammation and marker of oxidative stress to investigate their impact on sperm parameters. MATERIALS AND METHODS The study is a prospective, longitudinal, pilot study over 18 months. Thirty-five men with spinal cord injury from 18 to 60 years of age were enrolled. Their mean age was 29.4 ± 6.4 years. Semen retrieval was scheduled every 6 months, allowing analysis of four ejaculates, in association with measurement of granulocyte and seminal plasma elastase concentrations to assess markers in semen for inflammation and spermatozoa DNA fragmentation to assess oxidative stress. RESULTS Based on reference limits, a normal total sperm number, decreased motility and vitality of the spermatozoa, and increased morphological abnormalities were found. Mean round cell and granulocyte concentrations were elevated in the semen. Markers in semen for inflammation and marker of oxidative stress were elevated in several semen samples, compared to reference limits. However, neither the presence of markers in semen for inflammation or oxidative stress, the completeness or the level of the spinal cord lesion, the age or the time post-spinal cord injury had a negative impact on the semen quality over time. DISCUSSION There was no significant decline in semen quality in spinal cord injury patients over time within the limitations of this pilot study. Moreover, a chronic genital inflammatory status was not associated with impairment of semen quality. CONCLUSION The present findings are reassuring for men with spinal cord injury and could guide the management of their reproductive ability. According to these preliminary data, not all spinal cord injury patients who are able to ejaculate require systematic freezing of their spermatozoa.
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Affiliation(s)
- Celine Chalas
- Laboratoire d'Histologie-Embryologie-Biologie de la Reproduction-CECOS, Cochin Academic Hospital, AP-HP, Centre Université de Paris, Paris, France
| | - Lea Jilet
- Unité de Recherche Clinique-Centre d'Investigation Clinique, Paris Descartes Necker/Cochin, Hôpital Tarnier, Paris, France
| | - Jean-Philippe Wolf
- Laboratoire d'Histologie-Embryologie-Biologie de la Reproduction-CECOS, Cochin Academic Hospital, AP-HP, Centre Université de Paris, Paris, France.,Institut Cochin, U 1016, Université de Paris, Paris, France
| | - Veronique Drouineaud
- Laboratoire d'Histologie-Embryologie-Biologie de la Reproduction-CECOS, Cochin Academic Hospital, AP-HP, Centre Université de Paris, Paris, France
| | - Hendy Abdoul
- Unité de Recherche Clinique-Centre d'Investigation Clinique, Paris Descartes Necker/Cochin, Hôpital Tarnier, Paris, France
| | - Catherine Patrat
- Laboratoire d'Histologie-Embryologie-Biologie de la Reproduction-CECOS, Cochin Academic Hospital, AP-HP, Centre Université de Paris, Paris, France.,Institut Cochin, U 1016, Université de Paris, Paris, France
| | - Pierre Denys
- Neuro-Uro-Andrology Raymond Poincare Academic Hospital, AP-HP, Garches, France.,Inserm U1179, UFR des sciences de la santé, University of Versailles Saint-Quentin, Montigny-le-Bretonneux, France
| | - Francois Giuliano
- Neuro-Uro-Andrology Raymond Poincare Academic Hospital, AP-HP, Garches, France.,Inserm U1179, UFR des sciences de la santé, University of Versailles Saint-Quentin, Montigny-le-Bretonneux, France
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7
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Ibrahim E, Aballa TC, Lynne CM, Brackett NL. Oral probenecid improves sperm motility in men with spinal cord injury. J Spinal Cord Med 2018; 41:567-570. [PMID: 28464732 PMCID: PMC6117571 DOI: 10.1080/10790268.2017.1320875] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
STUDY DESIGN Prospective cohort study (twenty men with spinal cord injury [SCI]). OBJECTIVE Determine if administration of oral probenecid results in improved sperm motility in men with SCI. SETTING Major university medical center. METHODS Twenty men with SCI were administered probenecid for 4 weeks (250 mg twice a day for 1 week, followed by 500 mg twice a day for 3 weeks). Semen quality was assessed at three time points: pre-treatment, post-treatment (immediately after the 4-week treatment), and follow-up (4 weeks after the last pill was ingested). RESULT(S) Probenecid was well-tolerated by all subjects. Sperm motility improved in each subject after 4 weeks of oral probenecid. The mean percent of sperm with progressive motility increased from 19% to 26% (P < 0.05). A more striking increase was seen in the mean percent of sperm with rapid linear motility, from 5% to 17%, (P <0.001). This improvement continued into the four week follow up period. Similar improvements were seen in the total motile sperm count (15 million, 28 million, and 27 million at pre-treatment, post-treatment, and follow-up, respectively). Sperm concentration was not significantly different at pre-treatment, post-treatment, and follow-up, (52 million, 53 million and 53 million, respectively). CONCLUSION This study showed that administration of an oral agent (probenecid) known to interfere with the pannexin-1 cellular membrane channel, can improve sperm motility in men with spinal cord injury. It is the first study to report improved sperm motility after oral medication in men with SCI.
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Affiliation(s)
- Emad Ibrahim
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA,Correspondence to: University of Miami Miller School of Medicine, The Miami Project to Cure Paralysis, Lois Pope Life Center, 1095 NW 14th Terrace, Room 1-10, Miami, FL33136, USA.
| | - Teodoro C. Aballa
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Charles M. Lynne
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA,The Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nancy L. Brackett
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA,The Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
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8
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Anderson R, Moses R, Lenherr S, Hotaling JM, Myers J. Spinal cord injury and male infertility-a review of current literature, knowledge gaps, and future research. Transl Androl Urol 2018; 7:S373-S382. [PMID: 30159244 PMCID: PMC6087847 DOI: 10.21037/tau.2018.04.12] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/04/2018] [Indexed: 12/15/2022] Open
Abstract
Spinal cord injury (SCI) affects nearly half a million new patients worldwide, with 17,700 in the US each year, and disproportionately impacts young males of reproductive age. Almost every aspect of male reproduction is affected by SCI, resulting in: erectile, endocrine and sexual dysfunction, decreased sperm motility despite an often-normal count, and abnormal semen emission and ejaculation. The aim of this review is to focus on how SCI impacts testicular spermatogenesis, sperm function, semen quality, and overall fecundity while discussing what is not known, and future avenues for research.
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Affiliation(s)
- Ross Anderson
- Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - Rachel Moses
- Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - Sara Lenherr
- Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - James M Hotaling
- Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - Jeremy Myers
- Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah, USA
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9
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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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10
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Iwahata T, Shin T, Shimomura Y, Suzuki K, Kobayashi T, Miyata A, Kobori Y, Soh S, Okada H. Testicular sperm extraction for patients with spinal cord injury-related anejaculation: A single-center experience. Int J Urol 2016; 23:1024-1027. [PMID: 27766729 DOI: 10.1111/iju.13226] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 09/06/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To present a single-center experience with testicular sperm extraction and intracytoplasmic sperm injection for fathering biological children in patients with ejaculatory dysfunction as a result of spinal cord injury. METHODS Testicular sperm extraction was carried out in 52 male patients with ejaculatory dysfunction as a result of spinal cord injury. We investigated sperm retrieval rates and pregnancy rates from medical records. Data on age, testicular volume, hormonal status (luteinizing hormone, follicle stimulating hormone and testosterone), and time since spinal cord injury were obtained and analyzed to detect potential associations with the presence of spermatogenesis. RESULTS Testicular sperm retrieval was achieved in 42 of 52 patients (80.7%). Intracytoplasmic sperm injection was carried out for 37 patients, and pregnancy was achieved in 32 (86.5%). The take-home baby rate was 70.2%. In the group with successful sperm extraction, testicular volume was significantly greater, time from spinal cord injury to extraction was significantly shorter, and serum luteinizing hormone and follicle-stimulating hormone levels were significantly lower. Serum follicle-stimulating hormone levels had the strongest association with feasibility of sperm retrieval by testicular sperm extraction. Furthermore, the sperm retrieval rates of patients injured within the preceding 12 years were significantly better than those injured longer before treatment (P = 0.045). CONCLUSIONS Testicular sperm extraction and intracytoplasmic sperm injection seem to provide favorable results for patients with ejaculatory dysfunction as a result of spinal cord injury. However, early testicular sperm extraction is recommended, because sperm retrieval becomes more difficult with time from spinal cord injury.
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Affiliation(s)
- Toshiyuki Iwahata
- Department of Urology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan
| | - Takeshi Shin
- Department of Urology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan.,Center for Reproductive Medicine, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan
| | - Yukihito Shimomura
- Department of Urology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan
| | - Keisuke Suzuki
- Department of Urology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan
| | - Tomohiro Kobayashi
- Department of Urology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan
| | - Akane Miyata
- Center for Reproductive Medicine, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan
| | - Yoshitomo Kobori
- Department of Urology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan
| | - Shigehiro Soh
- Department of Urology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan
| | - Hiroshi Okada
- Department of Urology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan.,Center for Reproductive Medicine, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan
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11
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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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12
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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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13
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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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14
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da Silva BF, Souza GHMF, Turco EGL, Del Giudice PT, Soler TB, Spaine DM, Borrelli M, Gozzo FC, Pilau EJ, Garcia JS, Ferreira CR, Eberlin MN, Bertolla RP. Differential seminal plasma proteome according to semen retrieval in men with spinal cord injury. Fertil Steril 2013; 100:959-69. [DOI: 10.1016/j.fertnstert.2013.06.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 06/06/2013] [Accepted: 06/06/2013] [Indexed: 11/30/2022]
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15
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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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Cunha M, Margalho P, Laíns J, Sánchez-Ramos A. A influência das prostatites crónicas do lesionado medular nas características do líquido seminal: dúvidas e verdades comprovadas. Rev Int Androl 2012. [DOI: 10.1016/s1698-031x(12)70071-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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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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18
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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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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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20
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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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Restelli AE, Bertolla RP, Spaine DM, Miotto A, Borrelli M, Cedenho AP. Quality and functional aspects of sperm retrieved through assisted ejaculation in men with spinal cord injury. Fertil Steril 2009; 91:819-25. [DOI: 10.1016/j.fertnstert.2007.12.060] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Revised: 12/17/2007] [Accepted: 12/17/2007] [Indexed: 10/22/2022]
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23
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Anderson KD, Borisoff JF, Johnson RD, Stiens SA, Elliott SL. Long-term effects of spinal cord injury on sexual function in men: implications for neuroplasticity. Spinal Cord 2006; 45:338-48. [PMID: 17016492 DOI: 10.1038/sj.sc.3101978] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Secure, web-based survey. OBJECTIVES Elicit specific information about sexual function from men with spinal cord injuries (SCI). SETTING World-wide web. METHODS Individuals 18 years or older living with SCI obtained a pass-code to enter a secure website and then answered survey questions. RESULTS The presence of genital sensation was positively correlated with the ability to feel a build up of sexual tension in the body during sexual stimulation and in the feeling that mental arousal translates to the genitals as physical sensation. There was an inverse relationship between developing new areas of arousal above the level of lesion and not having sensation or movement below the lesion. A positive relationship existed between the occurrence of spasticity during sexual activity and erectile ability. Roughly 60% of the subjects had tried some type of erection enhancing method. Only 48% had successfully achieved ejaculation postinjury and the most commonly used methods were hand stimulation, sexual intercourse, and vibrostimulation. The most commonly cited reasons for trying to ejaculate were for pleasure and for sexual intimacy. Less than half reported having experienced orgasm postinjury and this was influenced by the length of time postinjury and sacral sparing. CONCLUSION SCI not only impairs male erectile function and ejaculatory ability, but also alters sexual arousal in a manner suggestive of neuroplasticity. More research needs to be pursued in a manner encompassing all aspects of sexual function.
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Affiliation(s)
- K D Anderson
- Department of Neurological Surgery, Reeve-Irvine Research Center, University of California, Irvine, CA 92697, USA
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24
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Oliva A, Multigner L. Ketotifen improves sperm motility and sperm morphology in male patients with leukocytospermia and unexplained infertility. Fertil Steril 2006; 85:240-3. [PMID: 16412767 DOI: 10.1016/j.fertnstert.2005.06.047] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Revised: 06/16/2005] [Accepted: 06/16/2005] [Indexed: 11/30/2022]
Abstract
In an open, uncontrolled study, the effect of 12 weeks of daily administration of ketotifen, an antihistamine-like drug with a mast cell stabilizing effect, on the semen quality of 55 men with leukocytospermia and unexplained infertility was examined. After 4 weeks of treatment, white blood cell count dramatically diminished and was accompanied by a significant improvement in sperm motility. A significant increase of morphologically normal sperm cells was observed at 8 weeks of treatment, and these changes remained until at least 4 weeks after the end of treatment.
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Affiliation(s)
- Alejandro Oliva
- Unidad de Andrologia, Servicio de Urologia, Hospital Italiano de Rosario, Rosario, Argentina
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25
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Brown DJ, Hill ST, Baker HWG. Male fertility and sexual function after spinal cord injury. PROGRESS IN BRAIN RESEARCH 2006; 152:427-39. [PMID: 16198718 DOI: 10.1016/s0079-6123(05)52029-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Spinal cord injury has an enormous impact upon the sexual relationship of a man and his partner. Erection may be partial or absent, orgasm altered or impossible, and fertility severely impaired. New understanding of the physiology of sexual function and improved treatment can enable most cord-injured men to achieve erections suitable for sexual satisfaction. Modern methods of sperm collection and fertility treatment mean that many can also be fathers. The best results are obtained by a team approach involving rehabilitation and reproductive medicine clinicians, nurses, spinal cord injury specialists and counselors with the cord-injured man and his partner. Erections can be achieved by drugs, such as sildenafil, that block phosphodiesterase 5, prolonging the action of nitric oxide with resultant smooth muscle relaxation. Intracavernosal prostaglandin E1 and mechanical systems, such as vacuum pumps and constriction rings, are also effective. Sexual gratification can be promoted in the context of an understanding relationship in which the cord-injured person can gain pleasure from pleasing his partner and also from his partner's exploration of erotogenic areas not affected by the spinal cord injury. An emphasis on the broader view of sexuality in relationships allows for a continuance and strengthening of bonds between the couple. Vibration ejaculation or electroejaculation can be used to collect semen. For a limited period in the acute phase, usually for about 6-12 days after injury, normal semen can be obtained by electroejaculation from some cord-injured men. With chronic spinal cord injury the semen is of variable quality. Some patients have necrospermia, which may be improved by regular ejaculation. Others have poor quality semen or spermatogenic disorders and, in this situation, in vitro fertilization techniques must be used to achieve parenthood. Trials of assisted ejaculation help individualize cost-effective management of the infertility.
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Affiliation(s)
- D J Brown
- Victorian Spinal Cord Service, Austin Health, Heidelberg, Vic., Australia.
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Basu S, Aballa TC, Ferrell SM, Lynne CM, Brackett NL. Inflammatory cytokine concentrations are elevated in seminal plasma of men with spinal cord injuries. ACTA ACUST UNITED AC 2004; 25:250-4. [PMID: 14760011 DOI: 10.1002/j.1939-4640.2004.tb02785.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The semen of most men with spinal cord injury (SCI) contains sperm with abnormally low motility. Studies suggest that the seminal plasma is the source of this condition. The seminal plasma of men with SCI contains an abnormally high number of white blood cells (WBC), specifically, activated T cells. It is known that activated T cells secrete cytokines and elevated concentrations of cytokines can be harmful to sperm. It is not known if the seminal plasma of men with SCI contains elevated concentrations of cytokines. The purpose of this study was to determine if the seminal plasma of men with SCI contained elevated concentrations of cytokines. Using the method of enzyme-linked immunosorbant assay (ELISA), ten cytokines were measured in the seminal plasma of men with SCI as well as healthy non-SCI control subjects. The cytokines of interest were grouped according to Th1 effector functions: interleukin 1 beta, interleukin 2, interleukin 12, tumor necrosis factor alpha, tumor necrosis factor beta, interferon gamma (IL1 beta, IL2, IL12, TNF alpha, TNF beta, INF gamma, respectively) and Th2 effector functions: interleukin 4, interleukin 6, interleukin 10, transforming growth factor beta 1 (IL4, IL6, IL10, TGF beta 1, respectively). The results showed a predominance of Th1 versus Th2 cytokine production in the seminal plasma of men with SCI compared with that of control subjects. This finding suggests an immunologic basis for infertility as a possible avenue of investigation in these men.
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Affiliation(s)
- Sarmistha Basu
- Miami Project to Cure Paralysis, University of Miami School of Medicine, Miami, Florida 33101, USA
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Nunez R, Murphy TF, Huang HF, Barton BE. Use of SYBR14, 7-amino-actinomycin D, and JC-1 in assessing sperm damage from rats with spinal cord injury. ACTA ACUST UNITED AC 2004; 61:56-61. [PMID: 15351989 DOI: 10.1002/cyto.a.20062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although fluorescent dyes combined with flow cytometry have been used to confirm the viability of sperm in the past, methods to detect damage to spermatozoa following injury have been limited to use of dyes, which are often difficult to adequately compensate for in a single laser system. METHODS In this article, we present what we believe is a better method to assess damage to sperm secondary to spinal cord injury in an in vivo model, for use with a standard Ar laser and flow cell. In this rat model of spinal cord injury leading to sperm damage, the spinal cords of the rats were injured, but the reproductive organs were not. To understand the origins of sperm injury, and to develop ways to overcome the loss of fertility, we used the viability dye SYBR-14 along with 7-amino actinomycin D to detect apoptosis. Additionally, we used the dye JC-1 to measure the changes in mitochondrial transmembrane potential that accompany the damage. RESULTS We found that SYBR-14 plus 7-amino actinomycin D was a useful method for quantifying apoptosis, particularly when another dye, such as JC-1, was used simultaneously. By using these dyes in concert with motility studies, we were able to quantify the extent of damage to sperm and correlate it to the decrease in motility of sperm (r(2) = 0.99 for SYBR14 versus motility and r(2) = 0.98 for JC-1 versus motility by regression analysis). CONCLUSIONS With a method established to measure injury to sperm, we hope to determine which treatment regimens of ones we will test are effective in restoring sperm to a more fertile state, in the future.
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Affiliation(s)
- Rafael Nunez
- Department of Medicine, Hematology/Oncology Section and Department of Pathology, University of Illinois, Chicago, Illinois, USA
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