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

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.

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?

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.

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