ABSTRACT
Spinal cord injury (SCI) most often affects young men of reproductive age: several millions of men between 16 and 45 years of age face quadriplegia or paraplegia worldwide. Acute SCI modifies hormonal and neural regulation of Sertoli and Leydig cells, which may affect the endocrine and/or paracrine microenvironment within the testis and impair the Sertoli support for normal spermatogenesis. A study on SCI dogs showed a significant impairment of sperm motility and spermatogenesis 3 weeks after SCI, compared with non-SCI controls. In animal models, during the chronic phase of SCI, auto-immunity and oxidative stress impair semen parameters. In chronic SCI patients, increased scrotal temperature is caused by the continuous sitting position and by a dysregulation of scrotal thermoregulation. Chronic SCI patients show high levels of reactive oxygen species in seminal fluid, which are inversely correlated to sperm motility. The management of SCI patients’ fertility involves a multidisciplinary staff and should be patient centered.
