Reproductive outcomes in infertile men with spinal cord injury (SCI): a retrospective case-control analysis

Objective: To evaluate semen characteristics and reproductive outcomes after assisted ejaculation methods with fresh in vitro fertilization/intracytoplasmic sperm injection cycles in patients suffering from spinal cord injury (SCI), compared to controls, affected by idiopathic male infertility (non-SCI group). Methods: SCI patients first underwent penile vibratory stimulation. Men “non-responders” to penile vibratory stimulation underwent electroejaculation. Third, testicular sperm aspiration was proposed. Results: This retrospective monocenter case-control study included 193 couples: 53 couples in SCI group and 140 couples in non-SCI group. Overall, 210 fresh in vitro fertilization/intracytoplasmic sperm injection cycles were performed. Median semen volume of SCI was significantly lower, compared to non-SCI (1.5 mL vs 3.1 mL; P < .01). Median sperm concentration/mL and total sperm count was considerably higher in SCI. Mean sperm progressive motility was significantly lower in SCI (5.0% vs 35.0%; P < .01). Normal fertilization rate was significantly lower in SCI (46.0% vs 71.0%; P < .01). Total fertilization rate was 50.0% and 75%, respectively, in SCI and non-SCI groups. A trend toward higher pregnancy rates per cycle was found in non-SCI (31.4% vs 21.4%), or in the live birth rate, which was 27.1% and 20.0%, respectively. No significant differences were found in pregnancy, miscarriage, and live birth rates per cycle, between the 2 groups. Conclusion: The assisted ejaculation methods in SCI proved to be efficacious and safe to obtain viable sperm for assisted reproductive technologies. Overall, pregnancy and live birth rates were similar to non-SCI patients. Thus, SCI men have the same opportunity to father biological children, compared to men without SCI.