Whether you and your partner have decided to try IUI or IVF, a semen sample is always almost always required in order to fertilize the egg. For most men, this isn’t a problem. However, some men are not able to produce a semen sample but would still like to have a biological child. In these instances, rectal electroejaculation may be beneficial.
What is Electroejaculation?
Electroejaculation (EEJ), or rectal electroejaculation (REE), is a type of fertility treatment that can help retrieve sperm from men who otherwise have difficulties producing ejaculate, usually due to neurological problems. Electroejaculation is a fairly simple procedure that uses a rectal probe to induce an erection and cause a man to ejaculate. This ejaculate is collected and prepared for use, usually in artificial insemination although it can also be used in IVF.
Who is Rectal Electroejaculation For?
This type of fertility treatment is not a common, first-line therapy for use in all men. Generally, it is reserved for men that have a high sperm count but, for one reason or another, fail to ejaculate. It is also treated as a final option when all other possible forms of treatment have been explored.
Common candidates for this type of procedure include men who have some type of neurological dysfunction that prevents them from ejaculating. This can include men with spinal cord injuries, who often have a hard time achieving and maintaining an erection as well as ejaculating. Without assistance, only about 5% of men with spinal cord injuries are able to conceive naturally. Through electroejaculation, though, these men are able to have an erection and produce enough ejaculate to help their partner conceive through ART.
Men with multiple sclerosis often have fertility problems as the disease can interfere with nerve reception in the body as well as inhibiting movement. In these instances, rectal electroejaculation may be suitable. Additionally, some diabetic men may require electroejaculation in order to fertilize their partner’s egg. Because diabetes can cause nerve damage as well as circulation problems, men with diabetes will often suffer from some type of sexual dysfunction. Usually, insulin-dependant diabetics are thought to be best suited to rectal electroejaculation.
Other men suited to this type of treatment include men who have had their testis removed (orchiectomy) as well as men who have had retoperitoneal lymph nod dissection (RPLND).
Performing Rectal Electroejaculation
An electroejaculation is a short procedure that is usually done in a hospital under general anesthetic. It involves a quick recovery time with most men able to return to work within a day.
Before the procedure, a man’s bladder will be emptied through an inserted catheter. Most men are also given a sodium bicarbonate bladder wash the day before in order to help neutralize the acid that is normally contained within urine, as this acid can often kill off sperm. Additionally, by doing the bladder wash, men who suffer from retrograde ejaculation can still have their sperm retrieved during the course of the treatment.
The majority of men receive general anesthetic beforehand although some men, like those with full spinal cord injuries, may not need it as their bodies are already desensitized to pain. Once the anesthetic has taken affect, the man is turned onto his right side and a plastic or metal tube (protocscope) that has been lubricated is inserted into the rectum. This device is used to examine the rectal lining in order to ensure that there are no lesions inside.
Once this is done, a probe is then inserted into the rectum. This probe is able to deliver electric currents to the rectal lining, increasing the volts at 4-second intervals. The volts help to stimulate the rectal wall, thereby producing an erection. Volts are slowly increased until a man ejaculates. The majority of men are able to ejaculate in under 20 volts.
In addition to the probe, an assistant also massages the prostate gland and urethra to induce ejaculation, which is collected in a sterilized container. The ejaculate can then be taken and prepared for IVF, ICSI or IUI. It can also be frozen and used in future treatments.
After the procedure, another protoscope will be inserted into the rectum in order to check for any trauma that may have occurred during the procedure.
As with any procedure that involves the use of general anesthetic, there is a risk of allergic reaction and possibly even death. However, this risk is very slight.
While the temperature of the probe is monitored throughout the procedure, there is the possibility of minor burns occurring if the probe becomes overheated. Generally, though, the probe is immediately removed or cooled down if its temperature exceeds 102ºF (39°C).
Men with spinal cord injuries are at particular risk for developing extremely high blood pressure (hyperflexia). In order to avoid this side effect, men consider to be at risk of this complication are given blood pressure medication beforehand.
Chances of conception through this method are generally pretty good although they do vary according to the chosen method of insemination. Electrojaculation coupled with ICSI and IVF usually produce the best results, with a 44% to 88% conception rate.