Fertility following spinal cord injury: a systematic review

Study design: Systematic review. Objectives: To review systematically fertility of persons with spinal cord injuries ( SCI) and their partners. Methods: Reports from six databases ( 1966 - 2003), selected annual proceedings ( 1997 - 2002) and manufacturer's information were screened against eligibility criteria. Searches covered female obstetrical issues, and the efficacy of vibration and electroejaculation for males, as well as advanced fertility ( AF) treatments for partners of SCI males. Data were pooled from case- series reports on SCI males' ejaculation, and pregnancies and live births for partners of SCI males. Results: In all, 2127 unique reports were evaluated, of which 66 reports were included. No studies investigated fertility in SCI females. Ejaculation interventions in the last decade resulted in response rates of 95% ( 95% confidence intervals ( CI) 91%, 99%), with 100% response rate reported in several recent publications. A total of 13 studies ( 1993 - 2001) yielded pregnancy rates of 51% ( 95% CI 42%, 60%) in partners of SCI males. Of these, 11 studies ( 1993 - 2003) yielded live birth rates of 41% ( 95% CI 33%, 49%). Conclusions: Fertility of SCI males is extensively studied. Semen for fertility purposes can generally be obtained using vibration and electroejaculation. AF techniques are increasing pregnancy rates. Research is needed to improve sperm quality. Freezing of sperm is unlikely to significantly improve fertility rates. Fertility of SCI females is addressed only in case reports and opinion articles. The opinion that female fertility is unaffected by SCI should be further investigated using appropriate research methodology.