Urologie pro praxi 4/2018

Multiple sclerosis and male infertility

Multiple sclerosis (MS) is a demyelinating disease of unknown etiology that affects the central nervous system – both the brain and the spinal cord. Male fertility can be compromised in the neurological patient by erectile dysfunction (ED), ejaculation disorder, impaired sperm quality or various combinations of these three disorders. ED can be managed by an increasingly invasive range of treatments including medications, injection therapy and the surgical insertion of a penile implant. Retrograde ejaculation is managed by medications to reverse the condition in mild cases and in bladder harvest of semen after ejaculation in more severe cases. Anejaculation might also be managed by medication in mild cases while assisted ejaculatory techniques including penile vibratory stimulation and electroejaculation are used in more severe cases. In cases where assisted ejaculation fails, sperm can be retrieved surgically from either the epididymis or from the testis. Once viable sperm cells have been obtained, there are used in assisted reproductive techniques, including intravaginal insemination, intrauterine insemination, and in vitro fertilization/ intracytoplasmic sperm injection. Only small research has been performed to evaluate fertility and sperm quality in SM men, so further clinical studies and close interdisciplinary collaboration are needed.

Keywords: multiple sclerosis, male infertility, treatment options.