We tried subcutaneous physostigmine 31 times in 24 spinal cord injured patients who had lost ejaculatory capacity. Normal semens were obtained in 4 patients(16.7%), subnormal semen in 1 patient(4.2%), a few sperms in 5 patients(20.8%), and no
sperm
in
14 patients(58.3%). Sperm appearance rate was 41.7%. Patients with injuries in cervical and upper thoracic levels ejaculated successfully more frequently than those with injuries in lower thoracic and lumber levels. The results of T12, L1, L2
injured
patients were not successful. Side effects included nausea and vomiting (91.7%), dizziness(45.8%) and headache(25.0%), but all patients could tolerate them, Significant adverse effects, particularly autonomic dysreflexia, were not found.
Artificial
uterine inseminations with sperms induced by subcutaneous physostigmine were performed in 3 cases, and all of these attempts were successful. We have 3 live births.
In conclusion, subcutaneous physostigmine for provoking ejaculation in anejaculatory spinal cord injury is cheap, easy to be performed and has no significant side effect.
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