Spinal Cord Injury And Fertility

Previously it was considered nearly impossible to become a father for a man who is suffering from an injury of spinal cord as it causes issues related to ejaculation and erection. But with advancement in the field of technology and science, convenient solutions have been found to overcome this matter such as collecting sperm without even ejaculating. Advance methods like artificial insemination increase the chances for men with spinal cord injury to become father just like other unaffected men.

How Spinal Cord Injury Affects The Male Fertility?

Male fertility is adversely impaired after the spinal cord injury. Given below are the factors that leads to impaired fertility in men after major spinal injury:

• Erectile dysfunction; a condition in which one fails to achieve a strong erection during the entire process of sexual intercourse. Due to sexual dysfunction, a man becomes less likely to indulge in sexual activities which minimize fertility.
• Impairment of ejaculating ability.
• Decline in sperm count; as spinal cord injury causes a significant reduction in the sperm count leading to a lower number of sperms in the ejaculate.
• Reduced quantity of normal functioning sperms in the ejaculate; as spinal cord injury makes the sperm non-functional therefore most of the sperm present in the ejaculate are not even viable or capable to fertilize an egg.

These impairments may or may not present simultaneously causing a 90-95% slash in the fertility rate in men suffering from spinal cord injury. Fortunately, assisted reproduction has turned out to be yet another blessing of science which has successfully increased the chances of fertilization in such men by up to 80%.

Nevertheless, it is important to prevent unwanted pregnancy regardless of the impaired fertility as fertilization may likely happen while having sexual intercourse. This only goes out for unwanted pregnancy but for planned pregnancy, there shouldn’t be a need of protection.

Treating Impaired Fertility

The main goal behind treating infertility is to restore the ability of a man to have a sexual intercourse, as in case of erectile dysfunction where due to lack of erection; the intercourse becomes only a dream. However, this cannot be the solution for every other problem.

Masturbation and vibratory stimulation can assist in achieving a state of climax for men with spinal cord injury, who find it difficult to ejaculate while having an intercourse. Then they can ejaculate by inserting their penis into vagina of their partner. If things don’t work out then by using vibratory stimulations or masturbation, men may ejaculate and then collect it using a sterilized plastic syringe which may be inserted into their partners’ vagina. In order to attain pregnancy, the sperm must be introduced into the vagina during the ovulation days of menstrual cycle.

Vibratory stimulations can be achieved by a penile vibrator. This tool tops all treatment methods and may be used for the fertilization process even at home in privacy. If this method does not assist in fertilization the other advanced approaches will be taken into consideration which will focus on both female fertility and male sperm.

Some other methods for collecting sperm include:

• Electro-ejaculation: in this method a long instrument inserted into the rectum of the man suffering from spinal cord injury, and it is placed next to the prostate. The electrical stimulation caused by the instrument makes the hypogastric nerve to start the process of ejaculation.
• Punch biopsy may be done to extract a small sample of the testicular tissue by means of surgery, for a careful examination and identification under a microscope followed by harvesting of sperm.
• By using a needle, sperm may be drawn from vas deferens.

Once the viable sperm collection is done through a desired opted method, the next fertility phase begins i.e. in-vitro fertilization (IVF). By using the viable sperm, the egg is fertilized into a test tube and then placed into the uterus of the partner so that it may implant, fertilize and grown into a fetus. At times, many eggs fertilize simultaneously and may be placed into the uterus so that once the embryo is formed; it may be frozen for later days to be used. In order to trigger the production of eggs, women are given female hormonal treatments. The harvesting of eggs is done via a minor surgery. All this effort is done to make fertilization easier for the sperm. Another modern IVF technique called ISCI (intracytoplasmic sperm injection) may also be used to directly inject the sperm into the egg.

How Spinal Cord Injury Affects The Female Fertility?

Spinal cord injury does not directly affect the fertility in women except the time right after the injury when usually there is menstrual cessation. This occurs due to temporary elevation of prolactin hormone in the serum as a result of spinal cord injury induced stress. The injury is followed by 3-6 months delayed menstrual periods after which the chances of fertility are back to normal.

References

• da Silva, B. F., Meng, C., Helm, D., Pachl, F., Schiller, J., Ibrahim, E., ... & Kuster, B. (2016). Towards understanding male infertility after spinal cord injury using quantitative proteomics. Molecular & Cellular Proteomics, 15(4), 1424-1434.
• Ibrahim, E., Brackett, N. L., & Lynne, C. M. (2016). Advances in the management of infertility in men with spinal cord injury. Asian journal of andrology, 18(3), 382.