Fertility preservation in men with spinal cord injury: The 2025 French guidelines

Abstract

Introduction: After spinal cord injury, most men cannot conceive without medical help. Therefore, this systematic review aimed to provide updated, high-quality recommendations up on fertility preservation (FP) in patients with spinal cord injury to urologists/andrologists, neuro-urologists, laboratory physicians, endocrinologists and other healthcare professionals.

Methods: These guidelines were based on a systematic review of studies published between January 1990 and June 2024 performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The analysis focused on three clinical questions: (i) What are the indications and procedures for FP in patients with spinal cord injury?; (ii) When should FP be proposed/carried out? What type of fertility monitoring should be carried out in patients with SCI with or without prior FP?; (iii) How to reduce the risk of infertility in this population?

Results: In total, 434 publications were screened and 115 met the inclusion criteria. Manual semen collection via masturbation may be considered as the first-line treatment. If masturbation fails or is impossible, penile vibratory stimulation (PVS) is recommended to induce ejaculation, especially in patients with supra-sacral lesions. If PVS fails, electroejaculation (EEJ) may be offered as second-line procedure to obtain retrograde ejaculation in patients with lesions below T10. In the absence of spermatozoa usable after masturbation and/or PVS and/or EEJ, surgical techniques (testis biopsy, extraction of spermatozoa from the epididymis or vas deferens) may be proposed.

Conclusions: These guidelines describe the recommended FP techniques for men with spinal cord injury to personalize their management.

Keywords: Blessures médullaires; Cryoconservation; Cryopreservation; Fertility preservation; Préservation de la fertilité; Spinal cord injuries.