Does the time from spinal cord injury affect the sperm retrieval rate in testicular sperm extraction? A multicenter cross-sectional study

Background: People with spinal cord injury (SCI) may suffer from anejaculation due to functional obstructive azoospermia (OA). Testicular sperm extraction (TESE) may successfully overcome this problem, even if the optimal timing is controversial. Objectives: The primary aim of this study was to report our experience with TESE in SCI, focusing on the effect of time since SCI event on the TESE outcomes. Materials and methods: We included all consecutive people with SCI and functional OA undergoing TESE between January 2011 and December 2021 in four Italian tertiary referral centers. We recorded TESE sample parameters, sperm retrieval rate (SRR) and intracytoplasmic sperm injection (ICSI) outcomes. Logistic regression analysis was performed to assess whether time since SCI was significantly associated with these outcomes. The time since SCI was considered in three different ways: (1) continuously; (2) ≤ 9 years vs. > 9 years; (3) ≤ 5 years, > 5 and ≤ 10 years, > 10 years. Results: We included 32 patients with tetraplegia and 75 with paraplegia, undergoing 107 TESE procedures. The median age at surgery and time since SCI were 33 years (IQR 29-38) and 9 years (IQR 3-14), respectively. The SRR was 81.3%. Thirty-three out of 87 patients underwent ICSI, achieving pregnancy in 63.6% after one cycle. The final live birth rate was 90.5%. Logistic regression analyses outlined that the SRR was not affected by considered variables, including time since SCI, considered both continuously and categorically. Conclusions: Our SRR did not prove to be negatively affected by all considered variables, specially by the time since SCI. Clinicians should not deter SCI patients with functional OA from undergoing TESE after long time since SCI.