Men with spinal cord injuries may have problems with ejaculation and subsequent fertility issues. At the Southwest Fertility Center for Men, vibratory stimulation may be a step forward towards helping these men improve their fertility potential. Read on for more information.In the US, 80% of new spinal cord injuries occur in men. 62% of these men are between the ages of 16 and 35. Spinal cord injury is not an uncommon cause of ejaculatory failure in young men and can be one of the most difficult to treat. The chronic nature of these injuries often predisposes these men to a decrease in their long-term fertility potential. The degree to which ejaculation are impaired depends largely on the level of the spinal cord injury. After rehabilitation, 90% of these men are not able to father children via sexual intercourse.
The probability that a man will retain his ability to ejaculate is the highest in men with injuries to the lower levels of the spinal cord and in men with incomplete lesions. Overall, 20% of spinal cord injured men are able to ejaculate in some fashion: either forward out of the penis (antegrade) or backwards into the bladder (retrograde). Fortunately, there are options for these men and their partners to build a healthy family. For those men who ejaculate forward out of the penis, natural conception is always the favored option, but the quality and quantity of sperm may require assisted reproductive techniques such as intrauterine inseminations. For those men who ejaculate backwards into the bladder, the sperm can be gathered from the bladder and prepared for intrauterine insemination if the quantity and quality are sufficient.
For those men who do not ejaculate, novel techniques have been developed that stimulate the intact neurologic centers that control ejaculation from below the level of the spinal cord injury. The two predominant methods are vibratory stimulation or electrical stimulation. Vibratory stimulation has a chance of working for spinal cord injuries above L2. The skin of the penis is intensely stimulated by rapid vibrations. The procedure does not require general anesthesia and often can be done in the outpatient setting. This vigorous vibratory stimulation sends signals to the intact ejaculatory control center which then responds by coordinating the proper nerves and muscles to produce an ejaculate that either comes out of the penis (antegrade) or goes backwards into the bladder (retrograde). The predominant vibratory stimulator used around the world and by Dr. Kuang at the Southwest Fertility Center for Men is the FertiCare Stimulator at www.medicalvibrator.com. Vibratory stimulation can be successful >80% of the time for injury levels at or above T10. A lower success rate of 15% is seen for injury levels below T10. Electrical stimulation uses a probe that is gently placed into the rectum. It electrically stimulates the nerves around the prostate to send signals to the nerve center that controls ejaculation. The success rate is around 95%, but it is invasive, requires general anesthesia and a trained physician. With either vibratory or electrical stimulation, there is an associated risk of autonomic dysreflexia. Autonomic dysreflexia is where the spinal cord injury has changed the way the nerves in your body respond to intense stimuli such as vibrations or electrical signals. Autonomic dysreflexia may present with severe hypertension, sweating and flushing. It can often be managed by stopping the stimulation or with medications.
For most spinal cord injury patients, an attempt at vibratory stimulation is a great first step since it is not invasive, does not require general anesthesia and can be performed in the clinic setting. If you need to pursue electroejaculation, Dr. Kuang will be more than happy to direct you to those who may help you with this process. It is important to note that for all patients with normal sperm production, sperm retrieval with in vitro fertilization is always another option.
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