L’AMP chez les blessés médullaires: quelles indications pour quels résultats?

The fertility of men with spinal cord injury (SCI) is severely impaired because of ejaculatory dysfunction and poor semen quality. Only a few patients are able to ejaculate during either sexual intercourse or masturbation. Fortunately, ejaculation can usually be obtained either by penile vibratory stimulation as first treatment option or electroejaculation as the second option. When assisted ejaculation techniques fail because of lack of response or complications such as autonomic dysreflexia, spermatozoa can be retrieved from the vas deferens or epididymis or directly from the testes. Motivated couples with adequate semen quality can be offered penile vibratory stimulation combined with self-insemination at home before resorting to assisted reproductive technology. However, most couples require an assisted reproduction technique. When semen quality is consistently good, up to three or four intrauterine inseminations can be initially recommended. However, this technique achieves only modest pregnancy results andin vitro fertilization techniques are often required. We perform standardin vitro fertilization (IVF) when semen quality is considered to be sufficient, otherwise we perform intracytoplasmic sperm injection (ICSI). With the new techniques now available, the majority of spinal cord injured men stand a fair chance of fathering a child. Availability of ICSI is important to maximize the probability of success for men with very poor semen quality. There are also a number of concerns about the safety of ICSI and the potential risks for the offspring. This new technique must therefore be used very cautiously and requires further surveillance.