The Effects of the Electroejaculation Procedure on Sperm. Motility

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1 Paraplegia 27 (1989) /89/ $10.00 :C' 1989 Internatinal Medical Sciety f Paraplegia The Effects f the Electrejaculatin Prcedure n Sperm. Mtility T. Linsentneyer, MD,! C. Wiltnt, MD,t R. U. Andersn, MD, FACS2 1 Department f Physcial Medicine and Rehabilitatin, Santa Clara Valley Medical Center, San Jse, Califrnia, 2 Divisin f Urlgy, Stanfrd University Schl f Medicine, Stanfrd, Califrnia, USA Sutntnary Electrejaculatin is becming mre available fr btaining semen frm spinal crd injured men wishing t father children. This study was undertaken t determine what effect the electrejaculatin prcedure itself had n sperm mtility. Factrs which were fund t impact n sperm mtility were smlarity, electric current and aqueus jelly lubricant used fr bladder catheterisatin. ph did nt affect sperm mtility. Key wrds: Infertility; Electrejaculatin; Sperm mtility. There has been renewed enthusiasm fr the use f electrejaculatin t btain semen frm spinal crd injured (SCI) males. This arse because f a recent reprt f the first pregnancies in the USA in which SCI men fathered children using this technique (Raymnd, 1987). This methd f management fr ejaculatry dysfunctin is cntinuing t increase in ppularity fr several reasns. An increasing number f centres are perfrming electrejaculatin, semen can be btained frm a majrity f patients, and this is the safest methd f btaining an ejaculate in thse prne t autnmic dysreflexia (Bennett et al., 1987; Brindley, 1981). Because many SCI males have retrgrade ejaculatin, the electrejaculatin prcedure requires catheterising the bladder, draining it f urine, and instilling a mre favurable physilgic ph-buffered smlar slutin. This is an attempt t minimise the adverse effects f urine n sperm mtility. Electrstimulatin is then perfrmed using a rectal prbe. After an adequate current is delivered, the bladder is recatheterised and the buffered slutin withdrawn and centrifuged t cncentrate any sperm that might be present. Semen quality is then assessed. If the sperm are f adequate mtility and number, they are used fr artificial inseminatin. Despite the ability t btain an ejaculate, semen quality is ften severely impaired fllwing SCI. Sperm mtility is mst frequently affected. This has been attributed t the effects f urine n retrgrade ejaculatins, recurrent Crrespndence t: T. A. Linsenmeyer, MD, Kessler Institute fr Rehabilitatin, Department f Urlgy, Pleasant Valley Way, West Orange, NJ , USA.

2 4 PARAPLEGIA bacteriuria, stasis f prstatic fluid, scrtal hyperthermia, hrmnal changes, and/r abnrmal testicular histlgy (Perkash et al., 1985). Because sperm mtility ften decreases fllwing spinal crd injury, it is imprtant t minimise any factrs that culd further inhibit mtility. This study was undertaken t determine if any aspects f the electrejaculatin prcedure itself affect sperm mtility. Methds This study specifically evaluated the effects n sperm mtility f ph, smlarity, electric current, and aqueus lubricant used fr catheterisatin f the bladder. Because f the pr sperm mtility typically fund in SCI males, and because SCI males' semen wuld have t g thrugh the entire electrejaculatin prcedure in rder t btain an ejaculate, ne r mre ejaculates were btained frm 5 nn-injured males. T determine the effects f ph and smlarity, each semen sample was divided int aliquts. The aliquts were mixed with 2 cc f saline. The smlarity and ph were independently varied. The ph and smlarity with the ptimum mtility fr each patient's semen sample was then recrded. In this way each patient served as his wn cntrl. Specific slutins fr this study were sterile saline and water fr intravenus use at 152 mosm, 218 mosm, 253 mosm, 289 mosm, 444 mosm, and 94 mosm at a cnstant ph f 7. Osmlarity was determined with a Dijimatic Osmmeter mdel 302. ph was varied between 4 and 8 at a cnstant smlarity f 289 mosm. ph was adjusted prir t additin f semen aliquts by adding sdium bicarbnate r hydrchlric acid using a Crning 125 ph meter. Electric current was evaluated using a Neurmetics Transcutaneus Nerve Stimulatry (TNS) unit, mdel number Spermatza were suspended in a saline slutin f 253 mosm at ph 7. Mtility was evaluated after 2 minutes f current at 100 rna, pulse width 20 us, and pulse frequency f Hz was applied. The result was then cmpared t cntrls. Aqueus lubricant cntaining a bacteristatic agent (1/ parts f phenyl mercuic brate) was diluted 1/100 parts in saline ph 7, 253 mosm. The sample was suspended in this slutin and sperm mtility was determined and cmpared t samples suspended in saline withut lubricant. Spermatza mtility fr this study was evaluated using multiple expsure phtgraphy and a Neubauer haemcytmeter. In the Figure the sperm tracts represent mtile sperm and the bright spts are nn-mtile sperm. The mtile and nn-mtile sperm were cunted and per cent mtility calculated fr each sample. Results N bvius effect f ph n sperm mtility was nted (Table I). Optimum mtility was divided evenly fr each ph f 4, 5,, 7 and 8. Osmlarity did appear t affect sperm mtility (Table II). An smlarity f 253 mosm prduced the best mtility the majrity f the time. Current was als fund t have an adverse effect n sperm mtility (Table III). In every case sperm

ELECTROEJ ACULA TION AND SPERM MOTILITY 47 Figure Example f sperm mtility evaluatin with multiple expsure phtgraphy. The light tracks (arrw) are mtile sperm. The bright dts are nn-mtile sperm.

3 ELECTROEJ ACULA TION AND SPERM MOTILITY 47 Figure Example f sperm mtility evaluatin with multiple expsure phtgraphy. The light tracks (arrw) are mtile sperm. The bright dts are nn-mtile sperm. Table I Effect f ph n sperm mtility with cnstant smlarity (284 mosm). Results expressed as per cent mtile sperm ph Sample * * * * 5 31* * * 48 *ph with best mtility fr each sample subjected t a 2-minute current f 100 rna, decreased mtility when cmpared t cntrls. Within 5 minutes f expsure t the aqueus lubricant/saline slutin (1/100), sperm mtilities drpped t mtility (Table IV). Discussin With imprvements in bth acute management and quality f life, a large number f SCI men have a strng desire t father children. This has becme an imprtant challenge fr thse wrking with the spinal crd injured. The use f e1ectrejaculatin is ne way this challenge is being met. Care needs t be taken, hwever, that sperm is btained in such a way that ptimum mtility is maintained.

4 48 PARAPLEGIA Table II cent mtile sperm Effect f smlarity n sperm mbility with cnstant ph 7. Results expressed as per Osmlarity Sample * * 5 2 I * * * * * * * * * 20 3 * Osmlarity with best mtility fr each sample Table III Effect f current (10 0 rna) fr 2 minutes n sperm mtility. Sperm suspended in saline at ph 7 and smlarity 284 mosm. Results expressed as per cent mtile sperm Sample N current mamps Table IV Effect f aqueus jelly lubricant n sperm mtility. Sperm suspended in saline at ph 7 and smlarity 253 mosm. Aqueus jelly lubricant diluted 1: 10 0 in saline Sample Saline Lubricant/saline 1: Urine is well knwn t have an extremely adverse effect n sperm. It has been nted that sperm mtility may decrease by at least half within 5 minutes f mixing with urine (erich et al., 1978). Traditinally this has been thught t be secndary t urine ph, hwever, ur results shw that smlarity shuld be the majr cncern when deciding n a slutin t instill int the bladder prir t electrejaculatin. There is n published literature discussing the effects f electrical current n sperm mtility. Preliminary results suggest that the current des adversely affect sperm mtility. One prblem in the field f electrjaculatin is that there is n agreement n parameters fr current delivered during electrstimulatin. Hrne, Paul and Munr, wh did the initial wrk with electrejaculatin in men, described an alternating current f 45 and 0 rna (1948). Brindley used a pulse generatr with a peak electrmtive frce f 99 V, 100 msec duratin, 30 pulse/secnd frequency. Bennett et al. used an average f 30 stimulatins f 15 V and 315 rna (1988). Further research n the effects f current n sperm mtility may help t standardise these parameters. Aqueus lubricant mixed with a 253 mosm sterile saline slutin (1/100 parts) was fund t have a significant adverse effect n sperm mtility. It is imprtant t nte that these cncentratins can easily be btained within the

5 ELECTROEJ ACULA TION AND SPERM MOTILITY 49 bladder because f repeated catheterisatins t drain the bladder f urine instilling small vlumes (20-30 cc) f buffer in the bladder during electrejaculatin. Additinally, lubricant becmes cncentrated in the centrifuged sperm pellet. We have fund that saline slutin alne prvides adequate lubricatin f the catheter fr insertin in mst cases. Techniques f the e1ectrejaculatin prcedure d appear t affect sperm mtility. The mst imprtant effects were frm smlarity, current and aqueus lubricant used fr catheterisatin. Because SCI men ften have pr semen quality, it is essential that the abve factrs be taken int cnsideratin. They may make the difference in achieving pregnancy. References BENNETT CJ, SEAGER SW, VASHER EA et al Sexual dysfunctin and electr ejaculatin in men with spinal crd injury: review. Jurnal f Urlgy 139: BRINDLEY GS Electrejaculatin: its technique, neurlgical implicatins and uses. Jurnal f Neurlgical Neursurgical Psychiatry 44: 9. CRICH JP, JEQUIER AM 1978 Infertility in men with retrgrade ejaculatin. Fertility and Sterility 30: HORNE HW Jr, PAUL DP, MUNRO D 1948 Fertility studies in the human male with traumatic injuries f the spinal crd and cauda equina. New England Jurnal f Medicine 239:959. PERKASH I, MARTIN DE, WERNER H 1985 Reprductive bilgy f paraplegics: results f semen cllectin, testicular bipsy and serum hrmnal evaluatin. Jurnal f Urlgy 134: RAYMOND CA 1987 New use f ld methd f inducing ejaculatin may give hpe f fatherhd t sme spinal crd injured men. Jurnal f American Medical Assciatin 258: :

INFERTILITY DIAGNOSIS

INFERTILITY DIAGNOSIS INFERTILITY Infertility is the inability t cnceive after 12 mnths f unprtected intercurse. There are multiple causes f infertility and a systematic way t evaluate the cnditin. Let s lk at sme f the causes.