Electroejaculation - Surgical Treatments of Male infertility

A complete failure of emission and ejaculation occurs most commonly from spinal cord injury (10,000 cases/ year in the United States) and as a result of deep pelvic or retroperitoneal surgery that injures the pelvic sympathetic nerves. With rectal probe electroejaculation, the pelvic sympathetic nerves undergo controlled stimulation, with contraction of the vas deferens, seminal vesicle, and prostate, such that a reflex ejaculation is induced. The semen is collected from the penis and the bladder, as retrograde ejaculation is often associated with electroejaculation. Semen acquired in this way generally requires assisted reproductive technology for success.

In men with anejaculation after retroperitoneal surgery or spinal trauma, successful recovery of sperm with electroejaculation is possible in the vast majority of patients. Sperm motility tends to be lower than normal when obtained in this way, an effect independent of electrical or heat effects inherent to the procedure. In men with spinal cord injuries above the T5 level, it is often possible to induce a reflex ejaculation with high-frequency penile vibration, termed vibratory stimulation. With the use of handheld vibrators set to a frequency of 100 cycles/s at an amplitude of 2-3 mm, patients may be taught to perform the procedure and attempt to conceive at home with cervical insemination.

Sperm Aspiration

Sperm aspiration techniques are indicated for men in whom the transport of sperm is not possible because the ductal system is absent or surgically unreconstructable. An example of this is vasal agenesis. Acquired forms of obstruction may also exist, the most common of which is failed vasectomy reversal. Aspiration procedures can involve microsurgery to collect sperm from the sperm reservoirs within the genital tract. At present, sperm are routinely aspirated from the vas deferens, epididymis, or testicle. It is important to realize that IVF is required to achieve a pregnancy with these procedures. Thus, success rates are intimately tied to a complex program of assisted reproduction for both partners (Table 42-16). In cases of sperm aspiration from the testicle and epididymis, IVF along with ICSI is required. An obvious prerequisite for these procedures is ongoing sperm production. Although evaluated indirectly by hormone levels and testis volume, the most direct way to verify sperm production is with a testis biopsy.

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