Electroejaculation combined with intracytoplasmic sperm injection in patients with psychogenic anejaculation yields comparable results to patients with spinal cord injuries

Capsule:
The combination of EEJ and ICSI gives adequate results for couples with anejaculation due to psychogenic etiology or spinal cord injury. Sperm retrieved by EEJ is characterized by asthenospermia and normal count.

Authors:
Itai Gat, M.D., Ettie Maman, M.D., Gil Yerushalmi, M.D., Ph.D., Micha Baum, M.D., Jehoshua Dor, M.D., Gil Raviv, M.D., Igal Madjar, M.D., Ariel Hourvitz, M.D.
Volume 97, Issue 5, Pages 1056-1060, May 2012

Objective:
To evaluate sperm quality and fertility potential of men with psychogenic anejaculation treated by electroejaculation (EEJ) and intracytoplasmic sperm injection (ICSI). Treatment results were compared to spinal cord injured (SCI) patients treated similarly.

Design:
Retrospective clinical study.

Setting:
Academic tertiary referral fertility center.

Patient(s):
Couples with isolated psychogenic anejaculation or SCI.

Intervention(s):
Electroejaculation and ICSI.

Main Outcome Measure(s):
Semen analysis, fertilization rate, implantation rate, pregnancy rate, delivery rate and safety of the procedure.

Result(s):
Fifteen patients diagnosed with psychogenic anejaculation underwent 40 EEJ/ICSI cycles. The semen retrieved was characterized by low motility (mean 10.7% ± 12.3%), normal volume (2.2 ± 1.9 mL) and normal count (25.1 ± 29.9 × 106/mL), according to World Health Organization criteria. Results of EEJ/ICSI were compared with 22 SCI patients treated by 66 EEJ/ICSI cycles during the same period. Mean female age and the number of oocytes retrieved per cycle were similar between the groups. Similar semen parameters after EEJ were found between psychogenic and SCI patients. Fertilization rate was significantly lower in the psychogenic patients compared to SCI (47.0% and 57.0%, respectively). No significant differences were found regarding pregnancy rates (20% and 22.7%, respectively), implantation rate (10.2% and 11.6%, respectively) or delivery rates (15% and 18.2%, respectively).

Conclusion(s):
Sperm retrieved by EEJ is characterized by asthenospermia and normal count. In spite of the lower fertilization rate in psychogenic patients, combination of EEJ and ICSI gives adequate results to couples with psychogenic anejaculation similar to the results obtained for SCI patients. Current results give these couples a reasonable chance of pregnancy achievement.

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