Fertility preservation in males with spinal cord, pelvic, and other injuries potentially impacting male fertility

Abstract

Fertility preservation in males with spinal cord injuries (SCI), pelvic trauma, traumatic brain injury (TBI), and other trauma-related conditions that impact male fertility and sexual function represents a crucial yet underexplored aspect of trauma medicine. These injuries can severely impair sperm quality, hormonal balance, and reproductive potential due to direct physiological damage and secondary effects, such as erectile and ejaculatory dysfunction. This review outlines the mechanisms by which these injuries impact fertility, examines the timeline of potential sperm quality deterioration, and evaluates both acute and chronic management strategies, including sperm retrieval techniques. In this context, the importance of early fertility counseling and timely cryopreservation is emphasized as a means to mitigate long-term impacts on quality of life, while a multidisciplinary approach-encompassing surgical, hormonal, and psychological interventions-is essential to optimize reproductive outcome. We highlight two key opportunities for intervention that trauma teams should consider: an early-stage andrologist consultation to assess fertility preservation options, and a later-stage consultation to address the frequent risk of sexual dysfunction. These simple steps-early sperm cryopreservation and follow-up for erectile and ejaculatory function-can meaningfully improve reproductive and psychosocial outcomes. By synthesizing current evidence, this article underscores the need for targeted research and standardized protocols to support fertility preservation in male trauma patients-an aspect of care that deserves greater attention given the potential of simple, timely actions to improve quality of life.

Keywords: Electroejaculation; Fertility preservation; Pelvic trauma; Penile vibratory stimulation; Spinal cord injuries; Surgical sperm retrieval.