Objective To compare semen parameters and intracytoplasmic sperm inje ction (IC SI) outcome in spinal cord-injured subjects who underwent single (group 1) or m ultiple (group 2) electroejaculations before ICSI. Design Prospective, randomize d, controlled study. Setting Department of gynecology, obstetrics, and pediatric science in a reproductive medicine unit at a major Italian university. Patient( s) Thirty-four healthy women with a male partner with SCI who were seeking assi sted reproduction services. Intervention(s) Transrectal electroejaculation, cont rolled ovarian hyperstimulation, and ICSI. Main outcome measure(s) Sperm concent ration, morphology, and motility and fertilization and pregnancy rates after ICS I. Result(s) Sperm was successfully retrieved in 94.1%of cases. In male subject s who underwent multiple electroejaculations, statistically significant improvem ents in sperm concentration and total sperm motility rate were observed. The ove rall fertilization rate was 63.6%. The number of oocytes retrieved and injected was comparable between the two groups. A total of nine clinical pregnancies wer e achieved. The pregnancy rate was statistically significantly higher in group 2 (n = 6/16; 37.5%) than in group 1 (n = 3/16; 18.75%). Conclusion(s) These dat a suggest that multiple electroejaculation has a positive effect on semen parame ters and ICSI outcome. Objective To compare semen parameters and intracytoplasmic sperm inje ction (IC SI) outcome in spinal cord-injured subjects who underwent single (group 1) or m ultiple (group 2) electroejaculations before ICSI. Design Prospective, randomize d, controlled study. of gynecology, obstetrics, and pediatric science in a reproductive medicine unit at a major Italian university. Patient (s) Thirty-four healthy women with a male partner with SCI who were seeking assi sted reproduction services. Intervention (s) Transrectal electroejaculation, cont rolled ovarian hyperstimulation, and ICSI. Main outcome measure (s) Sperm concent ration, morphology, and motility and fertilization and pregnancy rates after ICS I. Result (s) Sperm was successfully retrieved in 94.1% of cases. multiple electroejaculations, statistically significant improve ents in sperm concentration and total sperm motility rate were observed. The ove rall fertilization rate was 63.6% . The number of oocytes retrieved and injected was comparable between the two groups. A total of nine clinical pregnancies wer e achieved. The pregnancy rate was statistically significantly higher than group 2 (n = 6/16; 37.5%) than in group 1 ( n = 3/16; 18.75%). Conclusion (s) These dat a suggest that multiple electroejaculation has a positive effect on semen parame ters and ICSI outcome.