Vibratory stimulation and rectal probe electroejaculation as therapy for patients with spinal cord injury: semen parameters and pregnancy rates.
OBJECTIVE
The conception rate of patients with spinal cord injuries following penile vibratory stimulation and rectal probe electroejaculation in conjunction with self-insemination, intrauterine insemination or assisted reproductive technique is poorly documented. We reviewed our success rates with penile vibratory stimulation and rectal probe electroejaculation, and the pregnancy rates achieved with self-insemination, intrauterine insemination and assisted reproductive techniques.


METHODS
A total of 78 consecutive patients with spinal cord injuries had a complete neurological examination and was treated initially with penile vibratory stimulation. If unsuccessful, rectal probe electroejaculation was performed to obtain an ejaculate. The ejaculate was then used with self-insemination, intrauterine insemination or assisted reproductive techniques and pregnancies were monitored.


RESULTS
Vibratory stimulation was successful in 20 of 37 patients (54%) with a cervical lesion, 14 of 26 (54%) with a lesion at or above T10 and none of 15 when the lesion was below T10. All patients except 2 who elected followup rectal probe electroejaculation had antegrade or retrograde ejaculate. Six patients (7.7%) with extremely poor semen quality were not candidates for assisted fertilization. Of 27 couples who attempted conception 17 were successful (5 self-insemination, 5 intrauterine insemination and 7 assisted reproductive techniques).


CONCLUSIONS
Penile vibratory stimulation should be used as first line therapy in patients with lesions above T10 while rectal probe electroejaculation should be considered as a second option. Motivated patients can achieve success with self-insemination, intrauterine insemination and assisted reproductive techniques.
Nehra
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A
Department of Urology, Boston University School of Medicine, Massachusetts, USA.
Werner
M A
MA
Bastuba
M
M
Title
C
C
Oates
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RD
D000328:Adult; D004542:Ejaculation; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D010812:Physical Stimulation / Q000295:instrumentation* / Q000379:methods; D011247:Pregnancy / Q000706:statistics & numerical data; D012007:Rectum; D012099:Reproductive Techniques; D013119:Spinal Cord Injuries / Q000150:complications*; D014732:Vibration