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Current Trends in Fertility
May 2007 -- How many men are still being told they won’t be able to father biological children after spinal cord injury? How many, when they learn this is not true, are also led to believe that the only way to achieve pregnancy is with the most expensive, complicated and invasive fertility procedure currently available?
Nancy L. Brackett, Ph.D., HCLD, director of the Male Fertility Research Program at The Miami Project has been at the forefront of research to understand and improve fertility impairments associated with SCI. “When a man with SCI and his partner consult with a fertility specialist, the doctor will often make recommendations for a specific procedure based on whether an ejaculated semen sample is available,” says Dr. Brackett. “Since men with SCI often have difficulty with ejaculation, semen retrieval is certainly an issue when seeking assistance from a fertility specialist.”
Before the 1980s, there was no reliable way to retrieve semen from a man with SCI who was unable to ejaculate. Since the 1980s, the introduction of procedures known as penile vibratory stimulation (PVS) and electroejaculation (EEJ) have significantly improved the chances of retrieving semen from men with SCI. “Much of our early research evaluated the feasibility and reliability of using PVS and EEJ for semen retrieval” reports Dr. Charles Lynne, a professor of urology and Brackett’s co-investigator. “These procedures are relatively simple to perform. In fact, as is the case with PVS, couples may be taught how to safely use this method on their own at home.”
But in a recent survey of professionals involved in the treatment of infertility, Brackett and colleagues found that more than one in four fertility centers don’t utilize PVS or EEJ. Rather, they rely on surgical sperm retrieval as the first line of therapy for anejaculation (lack of ejaculation) in men with SCI. Unfortunately, this approach commits the couple to the most invasive and expensive reproductive option, (intracytoplasmic sperm injection), when less invasive and less expensive options such as intravaginal insemination or intrauterine insemination may be possible.
Dr. Brackett’s group found that these centers were not examining the semen samples of men with SCI as a source of sperm for ART. Professionals cited a lack of training and equipment as their main reasons for not offering PVS or EEJ.
In an effort to get the word out to medical professionals who offer fertility services to couples where the male partner has an SCI, Brackett has presented data on semen quality and pregnancy outcomes that support a rationale for examining the semen samples as a source of sperm for ART. Her findings were highlighted in a Modern Trends article in the October 2006 issue of Fertility and Sterility where she emphasized that fertility specialists need to explore all reproductive options, rather than proceeding immediately to the most invasive and expensive ART in these couples. Likewise, men with SCI and their partners should be aware that less invasive options are available. In consultation with their infertility specialist, couples should explore all available options.
For further reading on fertility following SCI, see www.scifertility.com for a “Guide and Resource Directory to Male Fertility following Spinal Cord Injury/Dysfunction” as well as a bibliography of Dr. Brackett’s studies
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