[Testicular Sperm Extraction in an Unmarried Male Patient with Spinal Cord Injury : A Case Report]

Spinal cord injury (SCI) patients often develop erectile dysfunction and ejaculatory dysfunction, and prolonged post-injury time can be complicated by impaired spermatogenesis. To obtain sperm, penile vibratory stimulation, electroejaculation or testicular sperm extraction (TESE) are required, followed by cryopreservation of the spermatozoa. This is a large physical and financial burden for SCI patients who wish to have children. In this report, we describe a case in which conventional TESE was performed in an unmarried male SCI patient. The patient was a 32-year-old male who suffered a cervical subluxation in a traffic accident when he was 23 years old, resulting in sensory and motor paralysis of the lower half of his body and motor paralysis and contracture of his fingers. He was unmarried but wanted to preserve his sperm for future use. With the diagnosis of obstructive azoospermia, conventional TESE was considered necessary. However, due to the risk of autonomic hyperreflexia, general anesthesia was required. Conventional TESE under general anesthesia was performed and motile spermatozoa were obtained from one testis. The sperm was cryopreserved at a fertility clinic. The mean Johnsen's score of the tissue was 10.0. Since the patient was an unmarried male and the purpose of the procedure was sperm preservation for future use, Japanese medical insurance did not cover these examinations, hospitalization and surgery costs. The financial burden of performing TESE and sperm preservation in unmarried male SCI patients is considerable. Even if infertility treatment is covered by medical insurance in Japan, this is still an issue that should be considered.