Electroejaculation and assisted reproductive technologies in the treatment of anejaculatory infertility

Objective: To determine the efficacy of electroejaculation in combination with assisted reproductive technology (ART).

Design: Case series.

Setting: University fertility program.

Patient(s): One hundred twenty-one consecutive couples seeking treatment of anejaculatory infertility.

Intervention(s): Electroejaculation with IUI, or gamete intrafallopian transfer or IVF.

Main Outcome Measure(s): Pregnancy and pregnancy outcome.

Result(s): Fifty-two couples became pregnant (43%), 39 by IUI alone (32.2%). Cycle fecundity for IUI was 8.7%. No difference in cycle fecundity was seen among ovarian stimulation protocols (clomiphene citrate, 7.6%, hMG, 13.2%, and natural cycle, 11.2%). Pregnancy was unlikely when the inseminated motile sperm count was <4 million. Female management protocol and etiology of anejaculation did not affect results. Patients undergoing IVF had higher cycle fecundity (37.2%) than did those undergoing IUI. The rates of spontaneous abortion and multiple gestations were 23% and 12%, respectively.

Conclusion(s): Electroejaculation with stepwise application of ART is effective in treating anejaculatory infertility. Intrauterine insemination with the least expensive monitoring protocol should be used for most couples, because use of more expensive monitoring did not improve results. It is cost-effective to bypass IUI and proceed directly to IVF in men who require anesthesia for electroejaculation and in those with a total inseminated motile sperm count < 4 million.