title: A comprehensive approach to the management of male infertility following spinal cord injury.
abstract: OBJECTIVE
  To review the outcomes of management of male infertility following spinal cord injury in a specialised fertility clinic.
  
  
  METHODS
  Retrospective review of medical records.
  
  
  METHODS
  The Fertility Clinic of a 45-bed spinal cord injury service in New South Wales, Australia.
  
  
  METHODS
  The medical and fertility clinic records of 113 males who attended the clinic between 1987 and 1997 were reviewed.
  
  
  RESULTS
  The rates of semen retrieval using vibroejaculation and electroejaculation were 67% and 97% respectively. Thirty-one individuals (37%) and their partners sought assistance with the primary aim of achieving a pregnancy. Intravaginal insemination (IVI) undertaken at home following vibroejaculation resulted in a pregnancy rate per cycle of 22%. Electroejaculation and IVI proved less successful with a pregnancy rate per cycle of only 5%, although with intrauterine insemination (IUI) this rate improved to 30%. Micromanipulation in vitro fertilisation (IVF) procedures, primarily intracytoplasmic sperm injection, were used in 18 couples resulting in a pregnancy rate per cycle of 19%. In the 31 couples there have been a total of 17 pregnancies in 97 cycle attempts for an overall pregnancy rate per cycle of 18% and a cumulative pregnancy rate per couple of 55%. Twelve of the pregnancies have resulted in 14 live births (including two sets of twins), there were three pregnancies ongoing at the date of review and there have been two spontaneous abortions.
  
  
  CONCLUSIONS
  The benefits of a specialised fertility clinic offering a comprehensive, client-focused approach with education, fertility assessment and a range of semen retrieval and assisted reproduction options, are highlighted.
authors.affiliation: Spinal Injuries Unit, Royal North Shore Hospital, Sydney, Australia.
authors.forename: S B
authors.initials: SB
authors.lastname: Rutkowski
authors.forename: T J
authors.initials: TJ
authors.lastname: Geraghty
authors.forename: D L
authors.initials: DL
authors.lastname: Hagen
authors.forename: D M
authors.initials: DM
authors.lastname: Bowers
authors.forename: M
authors.initials: M
authors.lastname: Craven
authors.forename: J W
authors.initials: JW
authors.lastname: Middleton
mesh_terms: D000293:Adolescent; D000328:Adult; D004542:Ejaculation; D004599:Electric Stimulation Therapy / Q000295:instrumentation*; D004864:Equipment and Supplies; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007248:Infertility, Male / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D007317:Insemination, Artificial, Homologous; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000503:physiopathology; D010812:Physical Stimulation; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology; D014732:Vibration