LIVING WITH SPINAL CORD INJURY: FERTILITY
Female fertility is not affected by spinal cord injury: for a woman of childbearing age, the ability to become pregnant persists unless she has some unrelated fertility problem. Menstruation may stop immediately after the injury, but usually resumes within six months. Keep in mind, however, that even during this early time, ovulation continues and you can become pregnant. The length and duration of your menstrual cycle may change after injury, and bleeding may be lighter or heavier.If you don’t want to become pregnant, some form of birth control is just as necessary after spinal cord injury as before. If you do become pregnant, there are special considerations for ensuring the health of you and your child, as discussed shortly.Male fertility after spinal cord injury is a more complex matter. For most men with spinal cord injury, fertility problems result from inability to ejaculate, from retrograde ejaculation (ejection of semen into the bladder rather than out of the penis), or from lowered sperm counts or decreased motility of sperm.Several techniques are available for obtaining sperm from men with spinal cord injury, for use in artificial insemination of a partner or for in vitro fertilization (fertilization, in the laboratory, of an egg that has been removed from the woman’s body and will be re-implanted as an embryo).In vibratory stimulation, a vibrator is applied to the penis to produce reflex ejaculation. This technique must be used with medical supervision owing to the risk of autonomic dysreflexia. The technique usually works only for men with lesions above T12, because thoracic and sacral pathways are necessary for the reflex.Another technique for obtaining sperm is electro-ejaculation, electrical stimulation of the prostate gland and seminal vesicles that produces muscle contraction and ejaculation. A specially trained clinician places the device in the man’s rectum and stimulates the genitals electrically through the intervening tissue, producing ejaculation. The procedure can be scheduled when the man’s partner is ovulating, and artificial insemination can be done immediately after. Or the sperm sample can be used for in vitro fertilization.A new technique for in vitro fertilization is intracytoplasmic sperm injection. This technique improves the chances of fertilization by selecting only the healthiest sperm cells in a given sample and then directly injecting the sperm into the egg cell using microscopic equipment.Depending on your individual situation, you may be able to father a child without medical intervention or with one of the techniques described above. An urologist who specializes in fertility can provide a thorough assessment of your individual situation and help you explore your options. The American Society of Reproductive Medicine can supply you with a list of medical centers that provide infertility treatments of all types.
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