Controversial Procedure Enables Disabled to Reproduce

Each year in the United States about 11,000 new spinal cord injuries affect men between the ages of 16 and 45. In Florida alone, there are almost 600 new cases of spinal cord injuries per year, leaving men unable to father children. Only 10 percent of those men can do so without medical assistance because of impairment in erection, ejaculation and semen quality. To answer that need, the Reproductive Medicine Group (RMG) announced that it is reintroducing the electro-ejaculation (EEJ) treatment in the Tampa Bay area. The technique, which uses electric shock waves to stimulate ejaculation, has been used in animals since the 1930s and in man since the late 1940s to help those suffering from ejaculatory dysfunction caused by spinal cord injury or neurological diseases such as multiple sclerosis and diabetes to father children. Dr. Sandy Goodman of RMG said that although not new, the procedure has been unavailable to most men as an option. "The nerves commonly injured during spinal trauma causes an inability to attain an erection through completion," Goodman explained. "We want to help them to realize the dream of having a family. We are now offering this procedure basically at cost to make it available and affordable to those who want to start, or add to, their families." Goodman said the reasons are varied why more reproductive specialists don't offer the outpatient procedure. "Equipment issues and also logistics have a lot to do with it," Goodman said. "For a long time, we didn't own our own IVF and surgery center, so logistically it was more difficult. People don't often have the equipment, or they're not trained, or it's difficult because it does require a multi-specialty team and sedation. They may not have all of these things available." Other physicians say it's not just about logistics; it's about the procedure itself and the risks involved. Autonomic hypereflexia is a potentially severe complication to any spinal cord injured man, because the normal defenses that protect against a sustained high blood pressure during orgasm are lost. This can cause brain hemorrhaging. Other problems that may occur include complications associated with the general anesthesia. Dr. Joseph Bird, reproductive endocrinologist at The Fertility Center of Chattanooga, said it's not about logistics in Chattanooga, but rather a lack of demand and the availability of other, less risky alternatives. "It's not that we're unwilling, but we don't get a lot of that diversity in a program this size," Bird noted. "I do know that the EEJ is a quite effective tool in accomplishing ejaculation when it's unable to occur during normal circumstances. But, another way to way to accomplish that is quite honestly through percutaneous epididymal sperm aspiration (PESA), which uses a little needle, placed in the epididymis, where the sperm is stored right before it is sent to the vas deferens to the ejaculatory duct. "The EEJ uses an electric probe into the rectum, where you run the risk of injury to the rectum and erectile tissues by burning that area, by sending electric shock through the tissues. It seems a little barbaric when you have other options. "This PESA is performed under local anesthesia with conscious sedation and doesn't require a general anesthesia and risk of electrocution. Both have their potential risks, but I think the risk associated with PESA is probably less risky and certainly from our patients' perspective they feel more comfortable going that route." Dr. David K. Walmer, chief of reproductive endocrinology and fertility at Duke University Medical Center, said he agrees there are other alternatives. In 20 years, he's never had a patient who had to have the EEJ. "Nowadays there are ways to surgically get sperm if you want to do something like in vitro fertilization," Walmer said. "We do aspirations at Duke all the time. I would never say that any procedure wouldn't have a use sometimes. But, a urologist can aspirate semen from the vas deferens or with a testicular biopsy. The EEJ involves a pulsing electrical current with general anesthesia. It is my understanding that that can actually have adverse affects on the sperm. The aspiration of sperm can be done under a nerve block. Each patient situation is different and has to go through the steps of evaluation. But, certainly you can get sperm that hasn't been subjected to an electrical current.