title: Vibratory stimulation and rectal probe electroejaculation as therapy for patients with spinal cord injury: semen parameters and pregnancy rates.
abstract: 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.
authors.affiliation: Department of Urology, Boston University School of Medicine, Massachusetts, USA.
authors.forename: A
authors.initials: A
authors.lastname: Nehra
authors.forename: M A
authors.initials: MA
authors.lastname: Werner
authors.forename: M
authors.initials: M
authors.lastname: Bastuba
authors.forename: C
authors.initials: C
authors.lastname: Title
authors.forename: R D
authors.initials: RD
authors.lastname: Oates
mesh_terms: 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