A step-wise approach to sperm retrieval in men with neurogenic anejaculation.
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.
Department of Urology, Roskilde Hospital, Koegevej 7-13, DK-4000 Roskilde, Denmark.
Mikkel
M
Fode
Department of Urology, University of Michigan, 1500 East Medical Center Drive, Box 0330, Ann Arbor, MI 48108, USA.
Dana A
DA
Ohl
Department of Urology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark.
Jens
J
Sønksen
D000465:Algorithms; D004542:Ejaculation; D004558:Electric Stimulation / Q000295:instrumentation; D004867:Equipment Design; D006801:Humans; D008297:Male; D012735:Sexual Dysfunction, Physiological / Q000209:etiology*; D053625:Sperm Retrieval; D013119:Spinal Cord Injuries / Q000150:complications*