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Conditions: Spinal Cord Injury

Spinal Cord Injury - Fertility

Men with spinal cord injury often experience a change in their ability to biologically father a child because they are generally incapable of ejaculating as a result of the spinal cord damage. The inability to ejaculate during intercourse is called anejaculation. Another problem men with spinal cord injury may experience is retrograde ejaculation. This is when semen does not leave the penis through its tip (the urethra), but instead goes into the bladder during ejaculation.

Additionally, although spinal cord injury does not interfere with a man's production of sperm, the resulting sperm cells may be less able to move.

There are several options available to assist men with spinal cord injury to improve their ability to have children.

If a man is unable to ejaculate, penile vibratory stimulation can be used to achieve an erection and eventually ejaculation. A variety of vibrators/massagers are available. Some are specifically designed with the output power required to induce ejaculation in men with spinal cord injuries. In vibratory stimulation, a vibrator applied to the tip of the penis, and the immediate surrounding area, causes vibrations to travel along the sensory nerves to the spinal cord and induce a reflex ejaculation. As a result, PVS may not work for men with certain spinal cord injuries. If a man lacks sensation in his genital area, as is the case for many men with spinal cord injuries, a vibrator must be used very carefully to avoid any bruising, bleeding or ulceration.

If vibratory stimulation fails, electroejaculation is the next in-line therapy. Rectal Probe Electroejaculation (RPE) is when a doctor inserts an electrical stimulation probe, called an electroejaculator, into the rectum, and the controlled electrical stimulation produces an ejaculation by stimulating ejaculatory nerves. General anaesthesia is usually required, except in some case of complete spinal cord injury whose pain and touch sensation is no longer present.Once the ejaculate is collected and the sperm quality is determined to be high enough, the sperm can then be used for artificial insemination.

If the above measures are not successful and fertility is the main concern, it is possible for a trained physician to extract sperm from the testicles and use in vitro fertilization (IVF) in order to initiate pregnancy (egg-sperm fertilization in a test tube and then inserted into uterus of mother) or single sperm injection can be attempted.

Men with certain spinal injuries have a better chance of response to these treatments. Therefore, men who are interested in fathering a child should get medical advice and treatment options from a fertility specialist experienced in issues of spinal cord injury to determine how successful each treatment is for each individual. The fertility specialist needs to be aware of methods that can improve sperm quality in men with spinal cord injury, as well as complications that can occur.

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