Rectal Electroejaculation

Many assisted reproductive techniques require a man to produce a semen sample in order to fertilize his partner’s egg outside of the womb. However, while most men are able to take matters into their own hands and produce a sample unassisted, some men cannot. For these men, there is rectal electroejaculation.


What is Rectal Electroejaculation?
Rectal electroejaculation (REE), also called electroejaculation (EEJ) is a process designed to help retrieve viable sperm from a man who otherwise has difficulty producing it. Used since 1948, this infertility treatment helps to stimulate a man to release ejaculate. Rectal electroejaculation uses a probe attached to an electric current to induce erection and ejaculation. Once ejaculate is released, it is then collected and prepared for use in artificial insemination.

Who Uses Rectal Electroejaculation?
Rectal electroejaculation is designed specifically to help certain groups of men who struggle with infertility. This fertility treatment is best suited for men with a high sperm count but low sperm quality. Generally, electroejaculation is not a first-line treatment, though, but instead a second-line treatment to be used after other options have been exhausted. Candidates for electroejaculation include:

Men with Spinal Cord Injuries: Every year there are more than 10,000 spinal cord injuries in the United States alone. Spinal cord injuries are a major cause of infertility because of the difficult they cause in maintaining an erection and achieving ejaculation. In fact, only 5% of men with spinal cord injuries will be able to have a baby with their partner without medical assistance. Men with spinal cord injuries often have a high sperm count but low-quality sperm (i.e. poor mobility) because sperm are trapped inside the body for such a long period of time. Rectal electroejaculation can help men with these injuries to achieve erection and produce enough ejaculate to produce a baby.

Diabetic Men: About 50% of men with diabetes will suffer from some sort of sexual dysfunction. Some of these fertility problems stem from psychological factors, but others are the result of nerve damage and circulation problems caused by the diabetes. Insulin-dependent diabetics are often excellent candidates for rectal electroejaculation.

Men with Multiple Sclerosis (MS): Multiple sclerosis is a disease that attacks the central nervous system causing extreme pain, weakness, and fatigue. Multiple sclerosis often results in infertility in men because it inhibits movement and nerve reception in the body. MS patients who wish to have a baby may be suited to rectal electroejaculation treatment.

How is the Procedure Performed?
This procedure is extremely safe and is performed in about 30 minutes. It is not done at a fertility clinic, but rather in hospital, as it usually requires general anesthetic. You should be able to return to work within a day. Before treatment begins, you will have a consultation with your doctor as well as a detailed physical exam, in order to determine your suitability for the procedure.

When you arrive for the treatment, a catheter will be inserted into your bladder in order to empty it completely. If your urine is particularly acidic, you may be given a sodium bicarbonate bladder wash to prevent the acid from killing any sperm. Many men suffer from retrograde ejaculation, in which ejaculate seeps back into the bladder after ejaculation. This sperm can be retrieved during the treatment and used for artificial insemination, necessitating the bladder wash.


You will most likely receive general anesthetic before the treatment begins. Some men with full spinal cord injuries will not need general anesthetic because they are desensitized to pain. Once your anesthetic begins to work, you will be placed on your right side. Your doctor will insert a protoscope, a plastic or metal, lubricated tube, into your rectum. This will help your doctor to inspect the lining of your rectum, to ensure that there are no lesions inside.

Next, a probe will be inserted into your rectum. This probe is attached to an electric supply that delivers the current to your rectal lining. The probe will stimulate your rectum’s wall in increasing volts, at intervals of about 4 seconds. The voltage of the current is increased slowly until it reaches 10 volts. If no ejaculation has taken place, the voltage will be increased. Most men ejaculate under 20 volts.

While the probe is in place, an assistant will massage the prostate gland and urethra. When ejaculation occurs, the assistant collects the ejaculate in a sterile container. This is then taken to be prepared for in vitro fertilization, intracytoplasmic sperm injection (ICSI) or to be frozen for future use. Another protoscope is inserted into the rectum to check for any trauma that may have occurred during the procedure.

Possible Complications
Rectal electroejaculation is a very safe procedure with few associated risks. However, any time anesthetic is used there is a risk of trauma, including death, although this risk is slight.

Minor burns can occur in the rectum if the electric probe gets too hot. The temperature of the electric probe is monitored throughout the procedure,though, and if it ever exceeds 102ºF (39°C) it is immediately cooled down or removed.

Men with spinal cord injuries are at risk for developing extremely high blood pressure, called autonomic hyperflexia. Usually, blood pressure medications are given before the procedure to at risk groups.

Benefits of the Treatment
After the treatment, the collected sperm can be washed and prepared for various types of artificial insemination. The chance of conceiving a child is fairly good, but depends upon the type of insemination chosen. IVF and ICSI produce the highest results, with a 44%-88% chance of conception. However, treatments are usually not covered by medical insurance and are expensive. Together with insemination, treatment will probably cost between $10,000 and $15,000.


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