Treatment of infertility in men with spinal cord injury: Medical progress and ethical considerations

Spinal cord injury (SCI) occurs most often in young men at the peak of their reproductive health. Following SCI, most men require medical assistance to reproduce. Recent improvements treating male factor infertility in general have led to a problem for men with SCI. Often, their ejaculates are not examined as a source of sperm for assisted reproductive technology (ART). Instead, sperm are retrieved surgically from their testes or epididymes as a first line of treatment for anejaculation. This development has resulted in many centers performing expensive and invasive ART to overcome the low sperm numbers typically obtained with surgical sperm retrieval (SSR). Expensive and invasive ART, however, is often unnecessary. Ninety-five percent of men with SCI respond to semen retrieval by penile vibratory stimulation (PVS) or electroejaculation (EEJ) and do not require SSR. Compared to SSR, PVS and EEJ usually result in higher yields of total motile sperm, thus increasing potentials for simpler, less expensive options such as intravaginal insemination or intrauterine insemination. Surveyed professionals cited lack of education and training regarding treatment options for SCI-related male factor infertility. This article outlines the current controversy and presents recommendations for improving treatment of SCI-related male infertility, including the requirement that such treatments adhere to standards for valid consent - standards that are too often overlooked or ignored.