F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
457
index to the viability of the sperm population and its suitability for fertilizing the ovum
(Harvey & Jackson, 1945).
Considerable variations were also found on detailed cytological examination in
the percentage of normal and abnormal forms of sperms and other cells. The following
case (case 17, Table 24) may serve as an example of detailed cytological examination,
the more so as a comparison is possible between two tests carried out in this patient.
This patient was wounded in June 1944 and sustained an incomplete cauda equina
lesion below L5. He had a cordotomy in October 1944, because of pain in right leg.
Recurrence of pain recurred after 3 weeks although less severe. He had erections and
nocturnal emissions 3 months after injury but lost emissions after cordotomy, however,
he still had spontaneous erections. He was able to walk.
First intrathecal prostigmine test 17 February 1948, 0-3 mg. Second test 5 November
1948,0-3 mg. He had 6 emissions on each occasion.
Table 29 shows the comparative microscopic results of seminal fluid in the two tests.
Table 30 shows 6 patients with negative results in repeated tests in spite of increased
dosage. It may be noted, however, that one single negative result does not necessarily
signify permanent infertility, as improvement of reproductive function is possible.
Actually, the prostigmine test may act as an induced stimulus on the function of the
reproductive organs. Three of our patients with negative results became fathers later—
one, an incomplete lesion below
Tj,
even of twins. Although, for obvious reasons, some
scepticism regarding paternity in these patients may be justified, the possibility of such
achievement cannot be ruled out.
It has already been mentioned, that one of the reasons for the prostigmin test is to
use the seminal fluid obtained for artificial insemination at the request of patients failing
to get ejaculations during intercourse. The first 4 cases have been reported previously
(Guttmann, 1960). They were all unsuccessful. However, the cause may not necessarily
be with the paraplegic male. In one of the cases, the examination of the wife revealed an
uterus bicornis and in another the wife was suffering from inflammation of the cervix.
In 10 more cases, artificial insemination has since been carried out by Dr Walsh. In two
cases, the wives conceived, but in one abortion took place after 3 months and in the other
after 5 months. No information is available about the gynaecological conditions of these
wives. Table 31 gives information about the number of artificial inseminations carried out
in 5 cases and the findings of the seminal fluid in these cases. However, that this method
can be used successfully has been shown by Dr R.Spira (1956), one of my former
co-workers, whose paraplegic patient—a complete 7th thoracic lesion—fathered a child
after three unsuccessful attempts by assisted insemination with the help of the intrathecal
prostigmin test. This case also shows that improvement of fertility is possible in the
paraplegic. Spira's patient was treated with Testosterone, 24 mg daily for 14 days and
Gonadotrophin 1,000 units daily for 4 weeks. We, also, have given hormonal treatment
combined with vitamin E 20 mg three times daily and in addition, in certain cases with
weak erections with Potensan (Medo) 2-3 pellets 2-3 times daily. Although we have seen
definite improvement of fertility, our results do not allow definite conclusions.
Recently Andres (1972) confirmed the effectiveness of the prostigmine test.
