F Andrew Celigoj, University of Miami Miller School of Medicine, Lois Pope Life Center, Miami, USA, and others reported in the August issue of the Journal of Urology that men who sustained a spinal cord injury before the age of 12 (ie, pre-pubertal) were associated with a significantly higher percentage of azoospermia than men with a spinal cord injury who were injured aged 12 or older.
Celigoj et al wrote that previous studies have shown that men with spinal cord injuries may have sexual health problems, such as erectile dysfunction or poor semen quality, but added that there was limited data on how a spinal cord injury sustained during childhood (ie, before puberty) affected semen quality and fertility because of the rarity of paediatric spinal cord injuries. They said: “We performed a retrospective chart review to identify subjects who were injured during the pre-puberty period [defined as 11.9 years or younger] and to characterise the semen quality of this population.” The investigators then compared the semen quality in this population with male spinal cord injury patients who had been injured at the age of 12 or older.
Celigoj et al found seven eligible patients (ages ranged from 4.4 years to 11.9 years at time of injury). They found that three patients who had been injured before the age of nine had no sperm in antegrade or retrograde ejaculate, two patients who had been injured at the age of 10 and 11.6 years, respectively, had subnormal sperm counts, and two patients who been injured at the age of 11.9 years had mean antegrade sperm concentration within normal ranges. Although all patients were able to achieve erections, only two were able to achieve an erection without medical assistance (via penile vibratory stimulation or electroejaculation). Celigoj et al reported that, overall, “The percent of azoospermic subjects in the pre-pubertal period (43%) was significantly higher than the percent of azoospermic subjects in our database who were injured after the age of 12 years (6.4%; Fisher’s exact test p=0.0092).”
The authors speculated that a spinal cord injury during pre-pubertal development may interrupt spermatogenesis and potentially cause azoospermia in adulthood. They added: “Although prior work has not been done in this area, these data suggest that there is neurological input at an early age required for spermatogenesis. Spermatogenesis appears to be preserved in subjects who sustained a spinal cord injury after the age of nine years.”
In the conclusion, Celigoj et al wrote: “Until more definitive studies can be performed, we recommend that all adults who sustained a spinal cord injury in childhood and who wish to father children undergo a standard fertility evaluation and be informed of the possibility of semen retrieval with penile vibratory stimulation and/or electroejaculation.”