Stimulation is of course stopped if the patient does not tolerate the procedure. in mild cases while assisted ejaculatory techniques including penile vibratory stimulation and electroejaculation are used in more severe cases. If these measures fail, surgical sperm retrieval can be attempted. Ejaculation with penile vibratory stimulation can be done by some spinal cord injured men and their partners at home, followed by in-home insemination if circumstances and sperm quality are adequate. The other options always require assisted reproductive techniques including intrauterine insemination or fertilization with or without intracytoplasmic sperm injection. The method of choice depends largely on the number of motile sperm in the ejaculate. the following two mechanisms: autonomic neuropathy, which causes ED and ejaculatory dysfunction, and concurrent vascular disease, which is a major cause of ED. ED affects 35%C75% of type 1 diabetic males13 and ejaculatory dysfunction is estimated to be present in approximately 40% of this group.14 Ejaculatory dysfunction can exhibit a slow progressive decline from a decreased amount of ejaculate-to-retrograde ejaculation to anejaculation depending on the degree of sympathetic autonomic neuropathy involved.14, 15 As with other long-term complications of diabetes, the occurrence of these conditions is related to how well the patient’s blood sugar is controlled.16 Furthermore, semen volume has been shown to be reduced in patients with diabetes (both types 1 and 2) compared to normal controls.17, 18, 19, 20, 21, 22 Results regarding morphology and motility are conflicting, even though most studies find one or both of these parameters reduced.18, 19, 20, 22 Also, increased sperm DNA damage has been detected in diabetic patients.17 Potential mechanisms behind the altered semen parameters in diabetic patients include endocrine disruption with reduced testosterone production and oxidative stress.23 The reduced semen volume may be caused by neurological damage as atony of the seminal vesicles has been shown in infertile diabetic patients with neuropathy.24 Both the sexual dysfunction and the potentially reduced semen quality can cause infertility. While the topic is still controversial, infertility has been found to be more prevalent in diabetic men than in non-diabetic controls,25 and a CUDC-305 (DEBIO-0932 ) recent retrospective analysis has found a high prevalence of subfertility (51%) among men with diabetes,26 thus highlighting the possible link between diabetes and infertility. Congenital spinal abnormalities Neural tube defects are congenital disorders of the spinal cord. The lumbar vertebrae are involved in more than 90% of cases, and the lower thoracic vertebrae in another 5% of cases.27 Most patients with these conditions have some kind of sexual dysfunction. Surgical treatment of these conditions can be a separate cause of neurological damage that creates further sexual dysfunction.28 The highest likelihood of becoming a father is found in men with lower and less severe damage.29 Sometimes, patients with lifelong ejaculatory dysfunction are found to have an occult dysplasia of the lower spinal cord, possibly with tethered cord syndrome. MS MS is a demyelinating disease of unknown etiology that affects the central nervous systemboth the brain and the spinal cord.30 The course of this condition varies; however, it usually progresses and increases in severity over time. Its effect on sexual function depends on the location of plaques in the central nervous system with the degree of sexual dysfunction not necessarily correlating to the duration of the condition.31 ED may be present in approximately 73% of men and ejaculatory dysfunction in about 50% of men with this condition.32 Reduced libido is reported in about 40%.32 Little research has been done to access fertility and the semen quality of male MS patients. However, a study from 2008 clearly points to reduced sperm counts, reduced sperm motility and altered sperm morphology in MS patients compared to normal controls.33 The diminished semen quality was particularly pronounced in patients with progressive disease. Possible explanations for the findings include a disturbed hypothalamusCpituitaryCtestis axis with reduced levels of sex hormones due to neurological damage, as well as reduced hormone production due to chronic inflammation. In addition to sexual dysfunction and reduced semen quality caused by the disease, MS patients may have reduced fertility as a consequence of adverse effects from their treatment. 34 SCI SCI induce a disruption of the nerve supply responsible for erectile function and ejaculation, which commonly causes both.Future studies are needed in order to gain a greater understanding of the psychological impact of infertility. Conclusion Neurological disorders can cause infertility through ED and ejaculatory dysfunction which can potentially cause severe psychological stress. can be attempted. Ejaculation with penile vibratory stimulation can be done by some spinal cord injured men and their partners at home, followed by in-home insemination if circumstances and sperm quality are adequate. The other options always require assisted reproductive techniques including intrauterine insemination or fertilization with or without intracytoplasmic sperm injection. The method of choice depends largely on the number of motile sperm in the ejaculate. the following two mechanisms: CUDC-305 (DEBIO-0932 ) autonomic neuropathy, which causes ED and ejaculatory dysfunction, and concurrent vascular disease, which is a major cause of ED. ED affects 35%C75% of type 1 diabetic males13 and ejaculatory dysfunction is estimated to be present in approximately 40% of this group.14 Ejaculatory dysfunction can exhibit a slow progressive decline from a decreased amount of ejaculate-to-retrograde ejaculation to anejaculation depending on the degree of sympathetic autonomic neuropathy involved.14, 15 As with other long-term complications of diabetes, the occurrence of these conditions is related to how well the patient’s blood sugar is controlled.16 Furthermore, semen volume has been shown to be reduced in patients with diabetes (both types 1 and 2) compared to normal controls.17, 18, 19, 20, 21, 22 Results regarding morphology and motility are conflicting, even though most studies find one or both of these parameters reduced.18, 19, 20, 22 Also, increased sperm DNA damage has been detected in diabetic patients.17 Potential mechanisms behind the altered semen parameters in diabetic patients include endocrine disruption with reduced testosterone production and oxidative stress.23 The reduced semen volume may be caused by neurological damage as atony of the seminal vesicles has been shown in infertile diabetic patients with neuropathy.24 Both the sexual dysfunction and the potentially reduced semen quality can cause infertility. While the topic is still controversial, infertility has been found to be more prevalent in diabetic men than in non-diabetic controls,25 and a recent retrospective analysis has found a high prevalence of subfertility (51%) among men with diabetes,26 thus highlighting the possible link between diabetes and infertility. Congenital spinal abnormalities Neural tube defects are congenital disorders of the spinal cord. The lumbar vertebrae are involved in more than 90% of cases, and the lower thoracic vertebrae in another 5% of cases.27 Most patients with these conditions have some kind of sexual dysfunction. Surgical treatment of these conditions can be a separate cause of neurological damage that creates further sexual dysfunction.28 The highest likelihood of becoming a father is found in men with lower and less severe damage.29 Sometimes, patients with lifelong ejaculatory dysfunction are found to have an occult dysplasia of the lower spinal cord, possibly with tethered cord syndrome. MS MS is a demyelinating disease of unknown etiology that affects the central nervous systemboth the brain and the spinal cord.30 The course of this condition varies; however, it usually progresses and increases in severity over time. Its CUDC-305 (DEBIO-0932 ) effect on sexual function depends on the location of plaques in the central nervous system with the degree of sexual dysfunction not necessarily correlating to the duration of the condition.31 ED may be present in approximately 73% of males and Rabbit polyclonal to cyclinA ejaculatory dysfunction in about 50% of males with this condition.32 Reduced libido is reported in about 40%.32 Little study has been done to access fertility and the semen quality of male MS individuals. However, a study from 2008 clearly points to reduced sperm counts, reduced sperm motility and modified sperm morphology in MS individuals compared to normal settings.33 The diminished semen quality was particularly pronounced in individuals with progressive disease. Possible explanations for the findings include a disturbed hypothalamusCpituitaryCtestis axis with reduced levels of sex hormones due to neurological damage, as well as reduced hormone production due to chronic inflammation. In addition to sexual dysfunction and reduced semen quality caused by the disease, MS individuals may have reduced fertility as a consequence of adverse effects using their treatment.34 SCI SCI induce a disruption of the nerve supply responsible for erectile function and ejaculation, which commonly causes both ED and anejaculation. Only about 9% of SCI males can ejaculate through masturbation or sexual intercourse.35 In addition, SCI can cause semen abnormalities in the form of low sperm motility and low sperm viability.36 Factors in sperm transportation/storage, the seminal plasma,37, 38, 39 and the immune system40, 41, 42, 43, 44, 45 have recently emerged as the most likely explanations for these abnormalities. Semen abnormalities are most likely to occur in SCI males who have total lesions of the spinal cord.46 As this condition most often happens in young men,47, 48, 49, 50, 51 fertility is a major concern for these individuals. Additional programs of neurologically induced sexual dysfunction include.