A Novel Therapy to Improve Reproductive Potential in Men with Spinal Cord Injury (SCI)
Abstract
The majority of men with a spinal cord injury are in the age range where raising a family is a major life goal. Ninety percent of these men will be infertile in large part because the spinal cord injury has caused a unique set of problems. (1) Most men with spinal cord injury cannot ejaculate with sexual activity so they are not able to get their wives pregnant in the usual manner; however, there are techniques available to easily obtain sperm in these cases. (2) Once sperm are obtained, 90% of the time, the quality of the sperm is not normal, with the majority of the sperm not moving or dead, and the sperm that are moving are moving poorly. To date, improvements to the sperm quality have been seen in the test tube in the laboratory. Recently, a pilot study was conducted on volunteer men with spinal cord injury which showed that there may be a type of medication which may be given orally to improve the infertile condition. This pilot study was the first to report an improvement in sperm motility after administration of an oral medication in men with a spinal cord injury. The improvement was seen within 1 month of taking the medicine. This research study will test the effect of a medicine, taken orally, that blocks a particular chemical pathway in the body that is linked to a cause of infertility (poor sperm motility) in men with a spinal cord injury. More specifically, it will determine if the infertility (sperm motility) is improved and if the medicine is well-tolerated by the subjects who are taking it. The safety of the medicine will be tested by examining the genetic material (DNA) the sperm carries inside of it. The study will also examine different dosages of the medicine. If the medicine is shown to be safe, the risks of giving an oral medication to improve fertility will be limited to the potential side effects of the medicine (so far minimal) and the benefits will be wide ranging. The benefits will impact social and quality of life issues for the man with a spinal cord injury and his family. There will also be benefits to the health care delivery system, and the field of medical research. Most men with spinal cord injury must depend on some form of medical assistance for semen retrieval. The choice of an assisted reproductive technique to achieve a pregnancy offered to any couple (with or without a male partner with spinal cord injury) generally is determined by the number of motile (strong swimming) sperm available. For example: The availability of 5 million motile sperm in the ejaculate separates the need for in vitro fertilization from intrauterine insemination (tremendously less costly and less complicated); and the presence of 15 million motile sperm in the ejaculate can allow many couples the chance for intravaginal insemination which can be taught to be carried out at home in many instances. Improvement in the number of motile sperm available for a couple s use results in the ability to individualize the care and assistance they need as well as in an improvement in medical resource utilization. In the field of medical research, the first remedy for a problem, whether surgical or medical, usually leads to other research looking for improvements over the original description. The medicine to be used in this study was chosen because it is already in use for other illnesses. The demonstration of its effectiveness will lead to further medical research such as whether the same mechanism for causing infertility is active in noninjured men (15% of the general population). Additionally, other medicines could be investigated which may be more effective. Also, different points in the chain of biochemical events may be targeted either alone, or in combination with the pathway we have concentrated on, that may produce a better overall result. We anticipate that this study will lead to improved treatment of infertility in men with spinal cord injury and allow for simpler, less expensive optio
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310720
Entities
People
- Emad Ibrahim
Organizations
- United States Army
- University of Miami