One of the big issues after spinal cord injury is the question of fertility. Spinal cord injury "generally" affects those in the prime of their lives - usually men between the ages of 18 and 35, although clearly anyone can suffer a traumatic spinal injury at any time. There are many misconceptions and untruths regarding fertility and this article shall attempt to set the facts straight on the subject.

The first misconception to be dispelled is: that there is no possibility of having a family after a spinal cord injury. Provided that there were no primary fertility problems prior to the injury this is certainly not the case - the possibility of having one's own children after spinal injury is a very real one and should be persued if this is what the couple wants.

Men and fertility.

There are many issues that men face after spinal cord injury related to sexuality and fertility. I will not discuss erectile disorders but will focus purely on fertility aspects.

The testes continue to manufacture sperm cells after injury. Yes, there are changes in temperature regulation, and certain studies show that, over time, some men produce sperm antibodies which affects sperm production but, on the whole, men are still able to produce sperm. In all cases though the quality of the sperm is affected - with abnormal sperm counts and morphological forms - but in my experience these parameters improve with time. One should avoid repeated infections of the testes (epididymo orchitis) as this reduces the chances of fertility. Any abnormal swelling of the testes should be treated immediately.

The greater problem in 99% of men with spinal injury is that they are unable to ejaculate. The first step in beginning a family then, is to establish if ejaculation is possible with assisted techniques. The simplest and most frequently used technique is Penile Vibratory Stimulation or PVS. These devices are available at some SCI clinics or home use devices can be purchased on the internet.

PVS uses a device that is able to produce a high frequency (99Hz) and amplitude of vibration to assist with a reflex ejaculation. This sample can then be used to inseminate the partner - either at home by simply introducing the collected semen into the vagina, or by more scientific means - usually by intra uterine insemination. These procedures are relatively cheap and, provided that insemination is done during the fertile time when the partner is ovulating, the chances of conception remain relatively good. PVS can be risky if the person suffers from hyper reflexia.

If this method fails then sperm can still be obtained through direct aspiration of the testis and sperm cells collected in this way. This however becomes a more costly procedure as this is followed by artificial fertility techniques such as IVF etc.

Women and fertility

Unlike men, spinal cord injury does not affect the fertility of woman who have become paralysed. It is not unusual for there to be a period of amenorrhoea after the injury, sometimes lasting up to five or six months but, once the cycle returns to normal, then normal fertility rates resume.

The issue then is not so much fertility, but the affect that pregnancy has on the spinal cord injured woman. Pregnant spinal cord injured women are more prone to urinary tract infections (UTI), pressure sores, bladder and bowel problems, hyper reflexia, anaemia and water retention. Premature labour can also be an issue and therefore early and close follow up by you gynaecologist is advised.