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Three major complications contribute to infertility in men with<jats:styled-content style=\"fixed-case\">SCI<\/jats:styled-content>: erectile dysfunction, ejaculatory dysfunction, and abnormal semen quality. Erectile dysfunction can be managed by regimens available to the general population, including oral administration of phosphodiesterase\u20105 (<jats:styled-content style=\"fixed-case\">PDE<\/jats:styled-content>\u20105) inhibitors, intracavernosal injections, vacuum devices, and penile prostheses. Semen may be obtained from anejaculatory men with<jats:styled-content style=\"fixed-case\">SCI<\/jats:styled-content>via the medically assisted ejaculation methods of penile vibratory stimulation (<jats:styled-content style=\"fixed-case\">PVS<\/jats:styled-content>) or electroejaculation (<jats:styled-content style=\"fixed-case\">EEJ<\/jats:styled-content>). Sperm retrieval is also possible via prostate massage or surgical sperm retrieval. Most men with<jats:styled-content style=\"fixed-case\">SCI<\/jats:styled-content>have abnormal semen quality characterized by normal sperm concentrations but abnormally low sperm motility and viability. Accessory gland dysfunction has been proposed as the cause of these abnormalities. Leukocytospermia is evident in most<jats:styled-content style=\"fixed-case\">SCI<\/jats:styled-content>patients. Additionally, elevated concentrations of pro\u2010inflammatory cytokines and elevated concentrations of inflammasome components are found in their semen. Neutralization of these constituents has resulted in improved sperm motility. There is a recent and alarming trend in the management of infertility in couples with<jats:styled-content style=\"fixed-case\">SCI<\/jats:styled-content>male partners. Although many men with<jats:styled-content style=\"fixed-case\">SCI<\/jats:styled-content>have sufficient motile sperm in their ejaculates for attempting intrauterine insemination (<jats:styled-content style=\"fixed-case\">IUI<\/jats:styled-content>) or even intravaginal insemination, surgical sperm retrieval is often introduced as the first and only sperm retrieval method for these couples. Surgical sperm retrieval commits the couple to the most advanced, expensive, and invasive method of assisted conception: in\u00a0vitro fertilization with intracytoplasmic sperm injection (<jats:styled-content style=\"fixed-case\">IVF<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">ICSI<\/jats:styled-content>). Couples should be informed of all options, including semen retrieval by<jats:styled-content style=\"fixed-case\">PVS<\/jats:styled-content>or<jats:styled-content style=\"fixed-case\">EEJ<\/jats:styled-content>. Intravaginal insemination or<jats:styled-content style=\"fixed-case\">IUI<\/jats:styled-content>should be considered when indicated.<\/jats:p>","DOI":"10.1111\/andr.12119","type":"journal-article","created":{"date-parts":[[2015,11,4]],"date-time":"2015-11-04T18:04:28Z","timestamp":1446660268000},"page":"13-26","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":77,"title":["Male fertility following spinal cord injury: an update"],"prefix":"10.1111","volume":"4","author":[{"given":"E.","family":"Ibrahim","sequence":"first","affiliation":[{"name":"The Miami Project to Cure Paralysis University of Miami Miller School of Medicine Miami FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. 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