title: Outcomes with intracytoplasmic sperm injection of cryopreserved sperm from men with spinal cord injury.
abstract: BACKGROUND
  Erectile dysfunction, ejaculatory dysfunction and poor semen quality are the main causes of infertility in men with spinal cord injury (SCI). Different sperm retrieval techniques such as penile vibratory stimulation (PVS), electro-ejaculation (EEJ) or surgical sperm retrieval (SSR) associated or not with sperm cryopreservation can be offered to these patients to preserve their fertility. If fatherhood cannot be achieved naturally, assisted reproductive techniques can be offered to these patients using either fresh or frozen/thawed sperm. The aim of the study was to report in SCI patients from Dijon (Burgundy) and in the literature, intracytoplasmic sperm injection (ICSI) outcomes using frozen sperm obtained either by antegrade ejaculation (PVS or sexual intercourse) or by SSR.
  
  
  METHODS
  A retrospective analysis was performed in Dijon, Burgundy over a 17 year period (1995-2011) on a cohort of 19 SCI men (6 quadriplegics and 13 paraplegics, mean age: 25.2 ± 5.6 years) who underwent a sperm cryopreservation followed or not by intracytoplasmic sperm injection (ICSI). Patients were divided into two groups according to the sperm retrieval method used (antegrade ejaculation group (n=10): penile vibratory stimulation (PVS) for 9 patients and sexual intercourse for 1 patient and surgical sperm retrieval (SSR) group: n=9). The sperm parameters in both groups were analyzed. Pregnancy outcomes in the 8 couples who underwent ICSI were evaluated.
  
  
  RESULTS
  The fertilization rates were 57 and 55%, the embryo's cleavage rates were 90 and 93% in the antegrade ejaculation and SSR groups respectively. Among the 8 couples who underwent ICSI, 5 couples achieved pregnancy. The pregnancy rates per couple were 50% and 75% in the antegrade and SSR groups respectively.
  
  
  CONCLUSIONS
  Although some studies don't recommend freezing sperm in SCI patients, the pregnancy rates presented in this study are encouraging and warrant the use of frozen/thawed sperm in very specific situations.
authors.affiliation: Hôpital de Dijon, Laboratoire de Biologie de la Reproduction, Université de Bourgogne, 21079 Dijon, France.
authors.forename: Shaliha
authors.initials: S
authors.lastname: Bechoua
authors.affiliation: Hôpital de Dijon, Laboratoire de Biologie de la Reproduction, Université de Bourgogne, 21079 Dijon, France.
authors.forename: Yasmine
authors.initials: Y
authors.lastname: Berki-Morin
authors.affiliation: Hôpital de Dijon, Service de Chirurgie Urologique-Andrologie, Université de Bourgogne, 21079 Dijon, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Michel
authors.affiliation: Hôpital de Dijon, Université de Bourgogne, Service de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, 21079 Dijon, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Girod
authors.affiliation: Hôpital de Dijon, Université de Bourgogne, Service de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, 21079 Dijon, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Sagot
authors.affiliation: Hôpital de Dijon, Laboratoire de Biologie de la Reproduction, Université de Bourgogne, 21079 Dijon, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Fauque
keywords: Assisted reproductive technology; Cryopreservation; Fertility; Pregnancy outcomes; Spinal cord injury