Editing Infertility: Management (section)

==== Technique ====

*'''<span style="color:#ff0000">Stimulation can be done with penile vibratory devices or electroejaculation'''
**'''<span style="color:#ff0000">Approach depends on level of spinal cord lesion[https://www.ncbi.nlm.nih.gov/pubmed/12406364 §]'''
***'''<span style="color:#ff0000">If lesion above T10, ejaculatory reflex arc will be intact so can stimulate with penile vibratory devices'''
***'''<span style="color:#ff0000">If lesion T10 or below, consider electroejaculation'''
***'''If these fail, sperm retrieval is performed'''
**'''<span style="color:#ff0000">Ejaculatory stimulation for men with spinal cord injuries may result in autonomic dysreflexia'''
***'''<span style="color:#ff0000">Autonomic dysreflexia'''
****'''See [[CUA: Neurogenic Lower Urinary Tract Dysfunction (2019)|2019 CUA NLUTD Guideline Notes]]'''
****'''An uninhibited sympathetic reflex accompanied by headache, diaphoresis, hypertension, bradycardia, and diaphoresis'''
****'''More common with spinal cord injury at a level of T6 or above'''
****'''<span style="color:#ff0000">Can be life-threatening.'''
****'''Pretreatment, 15 minutes before the procedure, with 20 mg of sublingual nifedipine is used'''
****'''Should have intravenous access and their blood pressure and pulse should be monitored every 2 minutes before, during, and for 20 minutes after ejaculatory stimulation.'''
****'''In the event of a sympathetic outflow (autonomic dysreflexia), termination of the procedure should be sufficient to break the response; however, intravenous access allows for delivery of sympatholytic agents should they become necessary'''