Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

A step-wise approach to sperm retrieval in men with neurogenic anejaculation

Nature Reviews Urology volume 12, pages 607–616 (2015)Cite this article

Subjects

Key Points

  • Any type of trauma or disease causing damage to the CNS and/or the peripheral nerves in, and around the pelvic floor can cause anejaculation

  • Penile vibratory stimulation (PVS) constitutes the cheapest and least invasive method of inducing ejaculation

  • In patients in whom PVS fails, electroejaculation has proved almost universally successful

  • Surgical sperm retrieval should be reserved strictly for patients in whom assisted ejaculation fails

  • The method of assisted reproductive technique should be chosen primarily based on the total motile sperm count

  • In selected cases, home insemination by the infertile couple themselves is feasible, by means of PVS and intravaginal self-insemination

Abstract

Normal fertility is dependent on intravaginal delivery of semen through ejaculation. This process is highly dependent on an intact ejaculatory reflex arc, which can be disrupted through any type of trauma or disease causing damage to the CNS and/or peripheral nerves. Neurogenic anejaculation is most commonly associated with spinal cord injury. This aetiology is especially relevant because most men with spinal cord injuries are injured at reproductive age. Assisted ejaculation in the form of penile vibratory stimulation is the first choice for sperm retrieval in such patients because it is noninvasive and inexpensive. In patients in whom vibratory stimulation fails, electroejaculation is almost always successful. When both methods of assisted ejaculation are unsuccessful, sperm retrieval by aspiration from either the vas deferens or the epididymis, or by testicular biopsy or surgery are reasonable options. In such cases the most inexpensive and least invasive methods should be considered first. The obtained semen can be used for intravaginal or intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Schematic drawing of the ejaculatory reflex.
Figure 2: A stepwise algorithm for treating neurogenic anejaculation.
Figure 3: The FertiCare® vibrator (Multicept A/S, Denmark).
Figure 4: The Viberect®-X3 (Reflexonic, USA).
Figure 5: The Seager Model 14 Electroejaculator (Dalzell Medical Systems, USA).

Similar content being viewed by others

References

  1. Fode, M. et al. Male sexual dysfunction and infertility associated with neurological disorders. Asian J. Androl. 14, 61–68 (2012).

    Article  PubMed  Google Scholar 

  2. O'Connor, P. Incidence and patterns of spinal cord injury in Australia. Accid. Anal. Prev. 34, 405–415 (2002).

    Article  PubMed  Google Scholar 

  3. Rathore, M. F., Hanif, S., Farooq, F., Ahmad, N. & Mansoor, S. N. Traumatic spinal cord injuries at a tertiary care rehabilitation institute in Pakistan. J. Pak. Med. Assoc. 58, 53–57 (2008).

    PubMed  Google Scholar 

  4. Kuptniratsaikul, V. Epidemiology of spinal cord injuries: a study in the Spinal Unit, Siriraj Hospital, Thailand, 1997–2000. J. Med. Assoc. Thai. 86, 1116–1121 (2003).

    PubMed  Google Scholar 

  5. Exner, G. & Meinecke, F. W. Trends in the treatment of patients with spinal cord lesions seen within a period of 20 years in German centers. Spinal Cord 35, 415–419 (1997).

    Article  CAS  PubMed  Google Scholar 

  6. Kafetsoulis, A., Brackett, N. L., Ibrahim, E., Attia, G. R. & Lynne, C. M. Current trends in the treatment of infertility in men with spinal cord injury. Fertil. Steril. 86, 781–789 (2006).

    Article  PubMed  Google Scholar 

  7. Giuliano, F. & Clement, P. Neuroanatomy and physiology of ejaculation. Annu. Rev. Sex Res. 16, 190–216 (2005).

    PubMed  Google Scholar 

  8. Coolen, L. M., Allard, J., Truitt, W. A. & McKenna, K. E. Central regulation of ejaculation. Physiol Behav. 83, 203–215 (2004).

    Article  CAS  PubMed  Google Scholar 

  9. Thomas, A. J. Jr. Ejaculatory dysfunction. Fertil. Steril. 39, 445–454 (1983).

    Article  PubMed  Google Scholar 

  10. Turek, P. J. Male Reproductive Physiology in Campbell Walsh Urology Vol. 1 (eds Wein, A. J., Kavoussi, L. R., Novick, A., Partin, A. & Peters, C.) 591–615 (Elsevier Saunders, 2012).

    Book  Google Scholar 

  11. Bohlen, D., Hugonnet, C. L., Mills, R. D., Weise, E. S. & Schmid, H. P. Five meters of H(2)O: the pressure at the urinary bladder neck during human ejaculation. Prostate 44, 339–341 (2000).

    Article  CAS  PubMed  Google Scholar 

  12. Colpi, G. et al. EAU guidelines on ejaculatory dysfunction. Eur. Urol. 46, 555–558 (2004).

    Article  CAS  PubMed  Google Scholar 

  13. Yavetz, H. et al. Retrograde ejaculation. Hum. Reprod. 9, 381–386 (1994).

    Article  CAS  PubMed  Google Scholar 

  14. Ohl, D. A., Quallich, S. A., Sonksen, J., Brackett, N. L. & Lynne, C. M. Anejaculation and retrograde ejaculation. Urol. Clin. North Am. 35, 211–220 (2008).

    Article  PubMed  Google Scholar 

  15. Kamischke, A. & Nieschlag, E. Update on medical treatment of ejaculatory disorders. Int. J. Androl. 25, 333–344 (2002).

    Article  CAS  PubMed  Google Scholar 

  16. Gilja, I., Parazajder, J., Radej, M., Cvitkovic, P. & Kovacic, M. Retrograde ejaculation and loss of emission: possibilities of conservative treatment. Eur. Urol. 25, 226–228 (1994).

    Article  CAS  PubMed  Google Scholar 

  17. Crich, J. P. & Jequier, A. M. Infertility in men with retrograde ejaculation: the action of urine on sperm motility, and a simple method for achieving antegrade ejaculation. Fertil. Steril. 30, 572–576 (1978).

    Article  CAS  PubMed  Google Scholar 

  18. Brackett, N. L., Ibrahim, E., Iremashvili, V., Aballa, T. C. & Lynne, C. M. Treatment for ejaculatory dysfunction in men with spinal cord injury: an 18-year single center experience. J. Urol. 183, 2304–2308 (2010).

    Article  PubMed  Google Scholar 

  19. Decter, R. M. et al. Reproductive understanding, sexual functioning and testosterone levels in men with spina bifida. J. Urol. 157, 1466–1468 (1997).

    Article  CAS  PubMed  Google Scholar 

  20. Frohman, E. M. & Wingerchuk, D. M. Clinical practice. Transverse myelitis. N. Engl. J. Med. 363, 564–572 (2010).

    Article  CAS  PubMed  Google Scholar 

  21. Haensch, C. A. & Jorg, J. Autonomic dysfunction in multiple sclerosis. J. Neurol. 253 (Suppl. 1), I3–I9 (2006).

    Article  PubMed  Google Scholar 

  22. Weinstein, M. H. & Machleder, H. I. Sexual function after aorto-lliac surgery. Ann. Surg. 181, 787–790 (1975).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Kedia, K. R., Markland, C. & Fraley, E. E. Sexual function after high retroperitoneal lymphadenectomy. Urol. Clin. North Am. 4, 523–528 (1977).

    CAS  PubMed  Google Scholar 

  24. Pearce, S., Steinberg, Z. & Eggener, S. Critical evaluation of modified templates and current trends in retroperitoneal lymph node dissection. Curr. Urol. Rep. 14, 511–517 (2013).

    Article  PubMed  Google Scholar 

  25. Genuth, S. Insights from the diabetes control and complications trial/epidemiology of diabetes interventions and complications study on the use of intensive glycemic treatment to reduce the risk of complications of type 1 diabetes. Endocr. Pract. 12 (Suppl. 1), 34–41 (2006).

    Article  PubMed  Google Scholar 

  26. Dunsmuir, W. D. & Holmes, S. A. The aetiology and management of erectile, ejaculatory, and fertility problems in men with diabetes mellitus. Diabet. Med. 13, 700–708 (1996).

    Article  CAS  PubMed  Google Scholar 

  27. Sexton, W. J. & Jarow, J. P. Effect of diabetes mellitus upon male reproductive function. Urology 49, 508–513 (1997).

    Article  CAS  PubMed  Google Scholar 

  28. Brindley, G. S. Reflex ejaculation under vibratory stimulation in paraplegic men. Paraplegia 19, 299–302 (1981).

    CAS  PubMed  Google Scholar 

  29. Brackett, N. L. Semen retrieval by penile vibratory stimulation in men with spinal cord injury. Hum. Reprod. Update 5, 216–222 (1999).

    Article  CAS  PubMed  Google Scholar 

  30. Sonksen, J. & Ohl, D. A. Penile vibratory stimulation and electroejaculation in the treatment of ejaculatory dysfunction. Int. J. Androl. 25, 324–332 (2002).

    Article  PubMed  Google Scholar 

  31. Sonksen, J., Biering-Sorensen, F. & Kristensen, J. K. Ejaculation induced by penile vibratory stimulation in men with spinal cord injuries. The importance of the vibratory amplitude. Paraplegia 32, 651–660 (1994).

    CAS  PubMed  Google Scholar 

  32. Brackett, N. L. et al. An analysis of 653 trials of penile vibratory stimulation in men with spinal cord injury. J. Urol. 159, 1931–1934 (1998).

    Article  CAS  PubMed  Google Scholar 

  33. Brackett, N. L., Kafetsoulis, A., Ibrahim, E., Aballa, T. C. & Lynne, C. M. Application of 2 vibrators salvages ejaculatory failures to 1 vibrator during penile vibratory stimulation in men with spinal cord injuries. J. Urol. 177, 660–663 (2007).

    Article  PubMed  Google Scholar 

  34. Kafetsoulis, A. et al. Abdominal electrical stimulation rescues failures to penile vibratory stimulation in men with spinal cord injury: a report of two cases. Urology 68, 204–211 (2006).

    Article  PubMed  Google Scholar 

  35. Giuliano, F. et al. Vardenafil improves ejaculation success rates and self-confidence in men with erectile dysfunction due to spinal cord injury. Spine (Phila Pa 1976) 33, 709–715 (2008).

    Article  Google Scholar 

  36. Courtois, F. J. et al. Blood pressure changes during sexual stimulation, ejaculation and midodrine treatment in men with spinal cord injury. BJU Int. 101, 331–337 (2008).

    Article  PubMed  Google Scholar 

  37. Leduc, B. E. et al. Midodrine in patients with spinal cord injury and anejaculation: A double-blind randomized placebo-controlled pilot study. J. Spinal Cord Med. 38, 57–62 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  38. Sonksen, J. Assisted ejaculation and semen characteristics in spinal cord injured males. Scand. J. Urol. Nephrol. Suppl. 2003, 1–31 (2003).

    Article  Google Scholar 

  39. Wieder, J. A., Brackett, N. L., Lynne, C. M., Green, J. T. & Aballa, T. C. Anesthetic block of the dorsal penile nerve inhibits vibratory-induced ejaculation in men with spinal cord injuries. Urology 55, 915–917 (2000).

    Article  CAS  PubMed  Google Scholar 

  40. Ekland, M. B., Krassioukov, A. V., McBride, K. E. & Elliott, S. L. Incidence of autonomic dysreflexia and silent autonomic dysreflexia in men with spinal cord injury undergoing sperm retrieval: implications for clinical practice. J. Spinal Cord. Med. 31, 33–39 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  41. Wan, D. & Krassioukov, A. V. Life-threatening outcomes associated with autonomic dysreflexia: a clinical review. J. Spinal Cord. Med. 37, 2–10 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  42. Elliott, S. & Krassioukov, A. Malignant autonomic dysreflexia in spinal cord injured men. Spinal Cord 44, 386–392 (2006).

    Article  CAS  PubMed  Google Scholar 

  43. Sheel, A. W., Krassioukov, A. V., Inglis, J. T. & Elliott, S. L. Autonomic dysreflexia during sperm retrieval in spinal cord injury: influence of lesion level and sildenafil citrate. J. Appl. Physiol. 99, 53–58 (2005).

    Article  PubMed  Google Scholar 

  44. Steinberger, R. E., Ohl, D. A., Bennett, C. J., McCabe, M. & Wang, S. C. Nifedipine pretreatment for autonomic dysreflexia during electroejaculation. Urology 36, 228–231 (1990).

    Article  CAS  PubMed  Google Scholar 

  45. Castle, S. M. et al. Safety and efficacy of a new device for inducing ejaculation in men with spinal cord injuries. Spinal Cord 52 (Suppl. 2), S27–S29 (2014).

    Article  PubMed  Google Scholar 

  46. Sonksen, J., Ohl, D. A. & Wedemeyer, G. Sphincteric events during penile vibratory ejaculation and electroejaculation in men with spinal cord injuries. J. Urol. 165, 426–429 (2001).

    Article  CAS  PubMed  Google Scholar 

  47. Suominen, J. J., Kilkku, P. P., Taina, E. J. & Puntala, P. V. Successful treatment of infertility due to retrograde ejaculation by instillation of serum-containing medium into the bladder. A case report. Int. J. Androl. 14, 87–90 (1991).

    Article  CAS  PubMed  Google Scholar 

  48. Perkash, I., Martin, D. E., Warner, H., Blank, M. S. & Collins, D. C. Reproductive biology of paraplegics: results of semen collection, testicular biopsy and serum hormone evaluation. J. Urol. 134, 284–288 (1985).

    Article  CAS  PubMed  Google Scholar 

  49. Sarkarati, M., Rossier, A. B. & Fam, B. A. Experience in vibratory and electro-ejaculation techniques in spinal cord injury patients: a preliminary report. J. Urol. 138, 59–62 (1987).

    Article  CAS  PubMed  Google Scholar 

  50. Braude, P. R., Ross, L. D., Bolton, V. N. & Ockenden, K. Retrograde ejaculation: a systematic approach to non-invasive recovery of spermatozoa from post-ejaculatory urine for artificial insemination. Br. J. Obstet. Gynaecol. 94, 76–83 (1987).

    Article  CAS  PubMed  Google Scholar 

  51. Shangold, G. A., Cantor, B. & Schreiber, J. R. Treatment of infertility due to retrograde ejaculation: a simple, cost-effective method. Fertil. Steril. 54, 175–177 (1990).

    Article  CAS  PubMed  Google Scholar 

  52. Okada, H., Goda, K., Koshida, M. & Kamidono, S. Pregnancy by insemination of cryopreserved spermatozoa from a man with retrograde ejaculation: a case report. J. Reprod. Med. 49, 389–391 (2004).

    PubMed  Google Scholar 

  53. Hsiao, W., Deveci, S. & Mulhall, J. P. Outcomes of the management of post-chemotherapy retroperitoneal lymph node dissection-associated anejaculation. BJU Int. 110, 1196–1200 (2012).

    Article  PubMed  Google Scholar 

  54. Kathiresan, A. S. et al. Anejaculatory infertility due to multiple sclerosis. Andrologia 44 (Suppl. 1), 833–835 (2012).

    Article  PubMed  Google Scholar 

  55. Hultling, C., Levi, R., Amark, S. P. & Sjoblom, P. Semen retrieval and analysis in men with myelomeningocele. Dev. Med. Child Neurol. 42, 681–684 (2000).

    Article  CAS  PubMed  Google Scholar 

  56. Ohl, D. A., Sonksen, J., Menge, A. C., McCabe, M. & Keller, L. M. Electroejaculation versus vibratory stimulation in spinal cord injured men: sperm quality and patient preference. J. Urol. 157, 2147–2149 (1997).

    Article  CAS  PubMed  Google Scholar 

  57. Iremashvili, V. V., Brackett, N. L., Ibrahim, E., Aballa, T. C. & Lynne, C. M. A minority of men with spinal cord injury have normal semen qualitycan we learn from them? A case-control study. Urology 76, 347–351 (2010).

    Article  PubMed  Google Scholar 

  58. Denil, J., Ohl, D. A., Menge, A. C., Keller, L. M. & McCabe, M. Functional characteristics of sperm obtained by electroejaculation. J. Urol. 147, 69–72 (1992).

    Article  CAS  PubMed  Google Scholar 

  59. Siosteen, A., Forssman, L., Steen, Y., Sullivan, L. & Wickstrom, I. Quality of semen after repeated ejaculation treatment in spinal cord injury men. Paraplegia 28, 96–104 (1990).

    CAS  PubMed  Google Scholar 

  60. Hamid, R., Patki, P., Bywater, H., Shah, P. J. & Craggs, M. D. Effects of repeated ejaculations on semen characteristics following spinal cord injury. Spinal Cord 44, 369–373 (2006).

    Article  CAS  PubMed  Google Scholar 

  61. Das, S. et al. Does repeated electro-ejaculation improve sperm quality in spinal cord injured men? Spinal Cord 44, 753–756 (2006).

    Article  CAS  PubMed  Google Scholar 

  62. Brackett, N. L., Lynne, C. M., Weizman, M. S., Bloch, W. E. & Padron, O. F. Scrotal and oral temperatures are not related to semen quality of serum gonadotropin levels in spinal cord-injured men. J. Androl. 15, 614–619 (1994).

    CAS  PubMed  Google Scholar 

  63. Ohl, D. A. et al. Fertility of spinal cord injured males: effect of genitourinary infection and bladder management on results of electroejaculation. J. Am. Paraplegia Soc. 15, 53–59 (1992).

    Article  CAS  PubMed  Google Scholar 

  64. Brackett, N. L., Lynne, C. M., Weizman, M. S., Bloch, W. E. & Abae, M. Endocrine profiles and semen quality of spinal cord injured men. J. Urol. 151, 114–119 (1994).

    Article  CAS  PubMed  Google Scholar 

  65. Basu, S. et al. Cytofluorographic identification of activated T-cell subpopulations in the semen of men with spinal cord injuries. J. Androl. 23, 551–556 (2002).

    PubMed  Google Scholar 

  66. Aird, I. A., Vince, G. S., Bates, M. D., Johnson, P. M. & Lewis-Jones, I. D. Leukocytes in semen from men with spinal cord injuries. Fertil. Steril. 72, 97–103 (1999).

    Article  CAS  PubMed  Google Scholar 

  67. Trabulsi, E. J., Shupp-Byrne, D., Sedor, J. & Hirsch, I. H. Leukocyte subtypes in electroejaculates of spinal cord injured men. Arch. Phys. Med. Rehabil. 83, 31–34 (2002).

    Article  PubMed  Google Scholar 

  68. Basu, S., Aballa, T. C., Ferrell, S. M., Lynne, C. M. & Brackett, N. L. Inflammatory cytokine concentrations are elevated in seminal plasma of men with spinal cord injuries. J. Androl. 25, 250–254 (2004).

    Article  CAS  PubMed  Google Scholar 

  69. Cohen, D. R. et al. Sperm motility in men with spinal cord injuries is enhanced by inactivating cytokines in the seminal plasma. J. Androl. 25, 922–925 (2004).

    Article  PubMed  Google Scholar 

  70. Brackett, N. L., Cohen, D. R., Ibrahim, E., Aballa, T. C. & Lynne, C. M. Neutralization of cytokine activity at the receptor level improves sperm motility in men with spinal cord injuries. J. Androl. 28, 717–721 (2007).

    Article  CAS  PubMed  Google Scholar 

  71. Ohl, D. A., Menge, A. C. & Jarow, J. P. Seminal vesicle aspiration in spinal cord injured men: insight into poor sperm quality. J. Urol. 162, 2048–2051 (1999).

    Article  CAS  PubMed  Google Scholar 

  72. Brackett, N. L., Davi, R. C., Padron, O. F. & Lynne, C. M. Seminal plasma of spinal cord injured men inhibits sperm motility of normal men. J. Urol. 155, 1632–1635 (1996).

    Article  CAS  PubMed  Google Scholar 

  73. Brackett, N. L., Lynne, C. M., Aballa, T. C. & Ferrell, S. M. Sperm motility from the vas deferens of spinal cord injured men is higher than from the ejaculate. J. Urol. 164, 712–715 (2000).

    Article  CAS  PubMed  Google Scholar 

  74. Qiu, Y., Wang, L. G., Zhang, L. H., Zhang, A. D. & Wang, Z. Y. Quality of sperm obtained by penile vibratory stimulation and percutaneous vasal sperm aspiration in men with spinal cord injury. J. Androl. 33, 1036–1046 (2012).

    Article  CAS  PubMed  Google Scholar 

  75. Iremashvili, V., Brackett, N. L., Ibrahim, E., Aballa, T. C. & Lynne, C. M. The choice of assisted ejaculation method is relevant for the diagnosis of azoospermia in men with spinal cord injuries. Spinal Cord 49, 55–59 (2011).

    Article  CAS  PubMed  Google Scholar 

  76. Bartak, V., Josifko, M. & Horackova, M. Juvenile diabetes and human sperm quality. Int. J. Fertil. 20, 30–32 (1975).

    CAS  PubMed  Google Scholar 

  77. Padron, R. S., Dambay, A., Suarez, R. & Mas, J. Semen analyses in adolescent diabetic patients. Acta Diabetol. Lat. 21, 115–121 (1984).

    Article  CAS  PubMed  Google Scholar 

  78. Ali, S. T., Shaikh, R. N., Siddiqi, N. A. & Siddiqi, P. Q. Semen analysis in insulin-dependent/non-insulin-dependent diabetic men with/without neuropathy. Arch. Androl. 30, 47–54 (1993).

    Article  CAS  PubMed  Google Scholar 

  79. Delfino, M., Imbrogno, N., Elia, J., Capogreco, F. & Mazzilli, F. Prevalence of diabetes mellitus in male partners of infertile couples. Minerva Urol. Nefrol. 59, 131–135 (2007).

    CAS  PubMed  Google Scholar 

  80. Agbaje, I. M. et al. Insulin dependant diabetes mellitus: implications for male reproductive function. Hum. Reprod. 22, 1871–1877 (2007).

    Article  CAS  PubMed  Google Scholar 

  81. Safarinejad, M. R. Evaluation of endocrine profile, hypothalamic-pituitary-testis axis and semen quality in multiple sclerosis. J. Neuroendocrinol. 20, 1368–1375 (2008).

    Article  CAS  PubMed  Google Scholar 

  82. La Vignera. S., Condorelli, R., Vicari, E., D'Agata, R. & Calogero, A. E. Diabetes mellitus and sperm parameters. J. Androl. 33, 145–53 (2012).

    Article  CAS  PubMed  Google Scholar 

  83. Shin, D. H. & Turek, P. J. Sperm retrieval techniques. Nat. Rev. Urol. 10, 723–730 (2013).

    Article  PubMed  Google Scholar 

  84. Goldstein, M. & Tanrikut, C. Microsurgical management of male infertility. Nat. Clin. Pract. Urol. 3, 381–391 (2006).

    Article  PubMed  Google Scholar 

  85. Wosnitzer, M. S. & Goldstein, M. Obstructive azoospermia. Urol. Clin. North Am. 41, 83–95 (2014).

    Article  PubMed  Google Scholar 

  86. Practice Committee of American Society for Reproductive Medicine. Sperm retrieval for obstructive azoospermia. Fertil. Steril. 90, S213–S218 (2008).

  87. Dieckmann, K. P., Heinemann, V., Frey, U. & Pichlmeier, U. How harmful is contralateral testicular biopsy?—an analysis of serial imaging studies and a prospective evaluation of surgical complications. Eur. Urol. 48, 662–672 (2005).

    Article  PubMed  Google Scholar 

  88. Donoso, P., Tournaye, H. & Devroey, P. Which is the best sperm retrieval technique for non-obstructive azoospermia? A systematic review. Hum. Reprod. Update 13, 539–549 (2007).

    Article  CAS  PubMed  Google Scholar 

  89. Boomsma, C. M., Heineman, M. J., Cohlen, B. J. & Farquhar, C. Semen preparation techniques for intrauterine insemination. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD004507. http://dx.doi.org/10.1002/14651858.CD00450.pub2.

  90. Duran, E. H., Morshedi, M., Taylor, S. & Oehninger, S. Sperm DNA quality predicts intrauterine insemination outcome: a prospective cohort study. Hum. Reprod. 17, 3122–3128 (2002).

    Article  CAS  PubMed  Google Scholar 

  91. Cantineau, A. E., Cohlen, B. J. & Heineman, M. J. Ovarian stimulation protocols (anti-oestrogens, gonadotrophins with and without GnRH agonists/antagonists) for intrauterine insemination (IUI) in women with subfertility. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD005356. http://dx.doi.org/10.1002/14651858.CD005356.pub2.

  92. Bensdorp, A. J., Cohlen, B. J., Heineman, M. J. & Vandekerckhove, P. Intra-uterine insemination for male subfertility. Cochrane. Database. Syst. Rev. Issue: 4. Art No.: CD000360. http://dx.doi.org/10.1002/14651858.CD000360.pub4.

  93. Goverde, A. J. et al. Ovarian response to standard gonadotrophin stimulation for IVF is decreased not only in older but also in younger women in couples with idiopathic and male subfertility. Hum. Reprod. 20, 1573–1577 (2005).

    Article  CAS  PubMed  Google Scholar 

  94. Yeh, J., Leipzig, S., Friedman, E. A. & Seibel, M. M. Results of in vitro fertilization pregnancies: experience at Boston's Beth Israel Hospital. Int. J. Fertil. 35, 116–119 (1990).

    CAS  PubMed  Google Scholar 

  95. Navot, D., Bergh, P. A. & Laufer, N. Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment. Fertil. Steril. 58, 249–261 (1992).

    Article  CAS  PubMed  Google Scholar 

  96. [No authors listed]. Assisted reproductive technology in the United States: 1996 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. Fertil. Steril. 71, 798–807 (1999).

  97. Schenker, J. G. & Ezra, Y. Complications of assisted reproductive techniques. Fertil. Steril. 61, 411–422 (1994).

    Article  CAS  PubMed  Google Scholar 

  98. Fauser, B. C., Devroey, P. & Macklon, N. S. Multiple birth resulting from ovarian stimulation for subfertility treatment. Lancet 365, 1807–1816 (2005).

    Article  PubMed  Google Scholar 

  99. della Ragione, T. et al. Developmental stage on day-5 and fragmentation rate on day-3 can influence the implantation potential of top-quality blastocysts in IVF cycles with single embryo transfer. Reprod. Biol. Endocrinol. 5, 2 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  100. Palermo, G., Joris, H., Devroey, P. & Van Steirteghem, A. C. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet 340, 17–18 (1992).

    Article  CAS  PubMed  Google Scholar 

  101. Kupker, W. et al. Use of frozen-thawed testicular sperm for intracytoplasmic sperm injection. Fertil. Steril. 73, 453–458 (2000).

    Article  CAS  PubMed  Google Scholar 

  102. Cohen, J. et al. Cryopreservation of single human spermatozoa. Hum. Reprod. 12, 994–1001 (1997).

    Article  CAS  PubMed  Google Scholar 

  103. Van Voorhis, B. J. et al. Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization. Fertil. Steril. 75, 661–668 (2001).

    Article  CAS  PubMed  Google Scholar 

  104. Ohl, D. A. et al. Electroejaculation and assisted reproductive technologies in the treatment of anejaculatory infertility. Fertil. Steril. 76, 1249–1255 (2001).

    Article  CAS  PubMed  Google Scholar 

  105. Sonksen, J. et al. Pregnancy after assisted ejaculation procedures in men with spinal cord injury. Arch. Phys. Med. Rehabil. 78, 1059–1061 (1997).

    Article  CAS  PubMed  Google Scholar 

  106. Lochner-Ernst, D., Mandalka, B., Kramer, G. & Stohrer, M. Conservative and surgical semen retrieval in patients with spinal cord injury. Spinal Cord 35, 463–468 (1997).

    Article  CAS  PubMed  Google Scholar 

  107. Nehra, A., Werner, M. A., Bastuba, M., Title, C. & Oates, R. D. Vibratory stimulation and rectal probe electroejaculation as therapy for patients with spinal cord injury: semen parameters and pregnancy rates. J. Urol. 155, 554–559 (1996).

    Article  CAS  PubMed  Google Scholar 

  108. Dahlberg, A., Ruutu, M. & Hovatta, O. Pregnancy results from a vibrator application, electroejaculation, and a vas aspiration programme in spinal-cord injured men. Hum. Reprod. 10, 2305–2307 (1995).

    Article  CAS  PubMed  Google Scholar 

  109. Rutkowski, S. B. et al. A comprehensive approach to the management of male infertility following spinal cord injury. Spinal Cord 37, 508–514 (1999).

    Article  CAS  PubMed  Google Scholar 

  110. Kathiresan, A. S. et al. Pregnancy outcomes by intravaginal and intrauterine insemination in 82 couples with male factor infertility due to spinal cord injuries. Fertil. Steril. 96, 328–331 (2011).

    Article  PubMed  Google Scholar 

  111. Leduc, B. E. Treatment of infertility in 31 men with spinal cord injury. Can. J. Urol. 19, 6432–6436 (2012).

    PubMed  Google Scholar 

  112. Sonksen, J., Fode, M., Lochner-Ernst, D. & Ohl, D. A. Vibratory ejaculation in 140 spinal cord injured men and home insemination of their partners. Spinal Cord 50, 63–66 (2012).

    Article  CAS  PubMed  Google Scholar 

  113. Hultling, C. et al. Assisted ejaculation and in-vitro fertilization in the treatment of infertile spinal cord-injured men: the role of intracytoplasmic sperm injection. Hum. Reprod. 12, 499–502 (1997).

    Article  CAS  PubMed  Google Scholar 

  114. Heruti, R. J. et al. Treatment of male infertility due to spinal cord injury using rectal probe electroejaculation: the Israeli experience. Spinal Cord 39, 168–175 (2001).

    Article  CAS  PubMed  Google Scholar 

  115. Shieh, J. Y. et al. A protocol of electroejaculation and systematic assisted reproductive technology achieved high efficiency and efficacy for pregnancy for anejaculatory men with spinal cord injury. Arch. Phys. Med. Rehabil. 84, 535–540 (2003).

    Article  PubMed  Google Scholar 

  116. Kathiresan, A. S. et al. Comparison of in vitro fertilization/intracytoplasmic sperm injection outcomes in male factor infertility patients with and without spinal cord injuries. Fertil. Steril. 96, 562–566 (2011).

    Article  PubMed  Google Scholar 

  117. Raviv, G., Madgar, I., Elizur, S., Zeilig, G. & Levron, J. Testicular sperm retrieval and intra cytoplasmic sperm injection provide favorable outcome in spinal cord injury patients, failing conservative reproductive treatment. Spinal Cord 51, 642–644 (2013).

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Roskilde Hospital, Koegevej 7-13, Roskilde, DK-4000, Denmark

    Mikkel Fode

  2. Department of Urology, University of Michigan, 1500 East Medical Center Drive, Box 0330, Ann Arbor, 48108, MI, USA

    Dana A. Ohl

  3. Department of Urology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, Herlev, DK-2730, Denmark

    Jens Sønksen

Authors
  1. Mikkel Fode
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dana A. Ohl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jens Sønksen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

M.F. researched data for and wrote the article. All authors made substantial contributions to discussion of content and reviewed/edited the manuscript before submission.

Corresponding author

Correspondence to Mikkel Fode.

Ethics declarations

Competing interests

M.F. declares that he has acted as a consultant and speaker for Astellas, Eli Lilly and Menarini. D.A.O. has acted as a consultant for Pfizer and a speaker for Eli Lilly. J.S. has acted as a consultant and speaker for Coloplast, Eli Lilly and Menarini and as a speaker for Astellas, and board member and shareholder in Multicept, Denmark.

PowerPoint slides

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fode, M., Ohl, D. & Sønksen, J. A step-wise approach to sperm retrieval in men with neurogenic anejaculation. Nat Rev Urol 12, 607–616 (2015). https://doi.org/10.1038/nrurol.2015.241

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrurol.2015.241

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing