[Electroejaculation and assisted reproductive techniques in the patients with spinal cord injury]

Analysis of limited fertility in intracytoplasmic sperm injection of sperm obtained by electroejaculation

Background and Aims:  We correlated findings in semen from patients with ejaculatory dysfunction with results of in vitro fertilization using their electroejaculated sperm. Methods and Results:  Electroejaculation was carried out in six patients with the above-mentioned criteria for a total of eight times. Sperm was obtained in six attempts. Intracytoplasmic injection of these sperm was performed in 156 eggs. Sixty-seven eggs were fertilized; most of these were injected with motile sperm. Two women became pregnant, both after injection with motile sperm. As previously reported, electroejaculated sperm showed low motility and a low fertilization rate, but even motile sperm had a low fertilization rate. Conclusion:  The results of the present study suggest the importance in fertilization of undetermined factors in addition to sperm motility. (Reprod Med Biol 2004; 3: 9-12).

Successful treatment of infertility due to anejaculation with in vitro fertilization and embryo transfer: a report of two cases

We investigated the efficacy of assisted ejaculation in combination with in vitro fertilization and embryo transfer (IVF-ET) in two couples with infertility due to anejaculation. Case 1 was in an anejaculatory condition associated with a spinal cord-injury. We performed intrauterine insemination (IUI) three times using motile sperm obtained by intrathecal injection of neostigmine, but no pregnancy followed. The couple then entered IVF-ET. The semen volume obtained by assisted ejaculation was 4.5 ml. The sperm count was 33 x 10(6)/ml with 33% motility. At 35 weeks of gestation she delivered three healthy babies by cesarean section. Case 2 was in an unexplained retrograde ejaculatory condition. We performed IUI eight times before changing to IVF-ET. We then used sperm obtained from urine or sperm recovered from the bladder after administration of human tubal fluid, but no pregnancy followed. At the fifth IVF-ET attempt, using sperm obtained from urine, we succeeded. We prepared the sperm by the Percoll gradient method. The sperm count was 36 x 10(6)/ml with 64% motility. At 39 weeks of gestation she delivered a healthy baby. Deficient seminal quality contributes to the decreased fertility potential in patients with anejaculation. With the use of IVF-ET methods, pregnancies can be achieved in these couples.