| Fertility | | | The following text has been taken from the chapter on parenthood in
Moving forward - The Guide to Living with Spinal Cord Injury. It was partly
written by Dr Peter Brinsden, Medical Director of Bourn Hall Clinic.
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The effect of spinal cord injury in: |
WOMEN |
The fertility of women is usually not affected by spinal cord injury. Your periods may
cease for a while after injury, but will normally resume within a few months. Most spinal
cord injured women conceive normally, have normal pregnancies and most will deliver
normally. If women do not conceive, the simpler fertility treatments such as intrauterine
insemination (IUI) will often be sufficient to achieve a pregnancy. Only a few will require
more sophisticated treatment like in vitro fertilization (IVF).
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MEN |
For men, however, the situation is different. Only about 3 per cent of spinal cord injured
men can father their own child without special assistance. Nevertheless, some men are
successful.
Spinal cord injury generally affects your ability to get and sustain an erection, to
ejaculate, and to produce viable sperm. Mechanical aids - vibrators, penile implants or
SARS - and injections (such as papaverine) can be helpful in procuring or sustaining
erection, but will not necessarily lead to ejaculation. However, it is possible to obtain
semen by electrical stimulation (see below), even if they cannot sustain an erection or
ejaculate. After spinal cord injury, both sperm density (number of million sperm per cc)
and sperm motility (% of moving sperm) tend to drop substantially, making it difficult to
fertilise the female partner’s egg. This may be due in part to changes in the
mechanisms which regulate the temperature of the testicles, and to the immobility and
higher scrotal temperature that come from prolonged sitting. Also, chronic infections in
the bladder, prostate and seminal vesicles (where sperm are stored) are common after
spinal cord injury, and can damage the sperm.
Occasionally, sperm is retro-ejaculated into the bladder, where the acidity of the urine
will rapidly kill it. It can be retrieved by passing a catheter, but will then need to be
carefully washed and prepared in the laboratory. Various methods have been evolved
to overcome these problems. There are three stages; collection of the sperm,
preparing the collected sperm and assisted conception.
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