Researchers at The Miami Project are studying the potential causes of fertility issues among men who have sustained a spinal cord injury. Most men, but typically not women, experience infertility because of impaired erectile function, an inability to ejaculate, and poor semen quality. Although sperm count tends to be normal, semen quality is impaired, with very little motility and low viability.
Two areas of focus for fertility researchers at The Miami Project are to improve semen retrieval and semen quality. Research shows that when the semen is obtained by “penile vibratory stimulation” rather than electroejaculation (an internal electrical stimulus), sperm motility is better. Recently, researchers at The Miami Project have found that poor sperm quality is caused by inflammatory proteins in the semen. Exciting new research indicates that sperm motility may be improved with a treatment that inhibits these inflammatory proteins.
We developed an educational program comprised of didactic classes and live workshops aiming at teaching health care professional dealing with patients with SCI on the optimal methods of management of reproductive function in men with SCI. Through this program and the developed educational video that over 100 practitioners worldwide learned the techniques of penile vibratory stimulation (PVS) and electroejaculation (EEJ) with the goal of spreading the knowledge of these simple techniques to avoid using surgical sperm extraction as the first choice for ART in couples with a male with SCI.
This guide was originally published in 2000 and, thankfully, there have been many advances since then. This booklet provides information about changes in male sexual function and fertility that may accompany spinal cord injury (SCI) and outlines the options available to deal with such changes. It is our hope that the information contained in this updated edition of our booklet can be used as a talking point for individuals and their medical professionals.
Dr. Emad Ibrahim, M.D., HCLD is the Director of The Miami Project’s Male Fertility Research Program initiated in 1990 by Drs. Richard P. Bunge and Nancy L. Brackett, formed to understand and improve impairments to male fertility that result from SCI. When the program was created, little was known about this topic. It was not known that most men with SCI have a unique semen profile characterized by normal sperm numbers, but abnormally low sperm motility. It was not known that toxic factors in the seminal plasma contribute to this problem. An algorithm of treatment had not yet been established. Physicians and scientists in the Male Fertility Research Program have made these discoveries as well as many more. The Miami Project Male Fertility Research Program is now widely recognized as the world leader in this field. Before this program started, men with SCI were often told: “You will never father children.” Now, most men with SCI can expect not only to father children, but to be provided with a treatment plan optimized for their needs. Since its inception, over 700 men have participated in the Male Fertility Research Program and over 200 babies have been born to couples through the program. The work of the Male Fertility Research Program continues to improve the quality of life for countless men with spinal cord injury and their loved ones.
Emad Ibrahim, M.D., HCLD (June 11, 2020)
Reproductive and Sexual Dysfunction in Men with Spinal Cord Injury