Conservative and surgical semen retrieval in patients with spinal cord injury.

Assisted semen retrieval was applied in 219 men with spinal cord injury (212 supranuclear, seven infranuclear lesions). Vibrostimulation in supranuclear lesions was successful in 133, and in five more after physostigmine injection. Electroejaculation was successful in all seven infranuclear lesions and in four supranuclear patients failing with vibrostimulation. Eight more supranuclear patients responded to electroejaculation and physostigmine. Surgical retrieval was applied in 27 patients. Nine Wagenknecht spermatoceles showed only one success, from all 18 implanted Brindley reservoirs semen could be collected. Three patients, in whom no pregnancy could be induced after Brindley reservoir implantation, had testicular sperm aspirated. In 109 patients who wanted to have offspring, 73 pregnancies could be induced in 46 couples, leading to 54 births (four twins), 16 abortions and three pregnancies. Conservative semen retrieval was possible in 82 of these men (63 pregnancies in 37 couples) and surgical methods were used in 27 (10 pregnancies in nine couples).