Fertility After SCI

Fertility issues can arise for spinal cord injury survivors, but a spinal cord injury does not have to mean giving up on parenting children. In the aftermath of a spinal cord injury, you might be so overwhelmed by your immediate needs that you give little thought to the future. But as things settle in and you begin to return to your everyday life, you may realize just how normal life with a spinal cord injury can feel. Eventually, being a spinal cord injury survivor will become just one facet of your identity—like your age, hair color, or college degree—not the sum total of who you are or can be.

When life returns to normal—or a new approximation of it—you might begin thinking about having a child. Discussing issues of fertility and sexuality with your doctor can be uncomfortable, especially since stigmatizing assumptions about SCI survivors continue to persist. But your injuries do not mean you cannot become a parent. A majority of SCI survivors have children, and many are active, engaged parents. You can be, too. Don't let your SCI thwart your parenting dreams. Here's what you need to know.

Biological Realities Are Different for Men and Women

Spinal cord injuries rarely directly affect women's fertility, though women may briefly cease ovulating after an injury. As long as a woman is able to have intercourse, she can often still get pregnant. For men, the picture is a bit murkier.

Because male sexual function depends on both voluntary and involuntary motor control, most spinal cord injuries impede fertility to some extent. The problem is not sperm quality, or even sperm production. Instead, the issue is that men who have survived spinal cord injuries often struggle to get or retain erections. Ejaculation, likewise, can prove difficult or impossible. If you are a man who wants to get your partner pregnant, begin the conversation with your doctor early, so you can explore your options.

Sexual Barriers Are Very Real

For both men and women, issues of sexuality are the primary obstacle to fertility. Women can get pregnant even if they are unable to become sexually aroused. Of course, this doesn't mean they should have to do it that way. But men cannot get their partners pregnant in the traditional way if they are unable to sustain an erection.

Both men and women may struggle to get aroused, and may not have any sexual sensations. This can thwart your desire to have sex, and may even lower your self-esteem. The good news is that a number of therapies can help you regain some functioning. Generally speaking, the lower the injury is, the more likely it is that you will recover some sensation.

What if you can't regain sexual function but still want to become a parent? There are a number of options that allow you to attempt intercourse to become a parent in the “natural” way. Men may use penis pumps or electrostimulation to induce an erection and aid in ejaculation. Some men also have good luck with erectile dysfunction drugs. Women often find that sexual lubricants help them safely have sex; look for a lubricant specifically designed for procreation, such as Pre-Seed. These lubricants help sperm move more efficiently, increasing your odds of a successful pregnancy.

Every spinal cord injury survivor is different, so you should not attempt any method for having intercourse without first discussing it with your doctor. You may also find that the assistance of a nonjudgmental and pragmatic sex therapist is helpful.

You May Have Other Injuries

Even if you have no other symptoms, a spinal cord injury may mean you have other injuries as well. For instance, even a minor blow to the head during a car accident can damage important regions of your brain, and life in a wheelchair can constrain nerve function in your genitals. Before you embark on a quest to become a parent, consider getting a full fertility workup to ensure that other issues related to your SCI will not prevent you from parenting a child.

Not All Fertility Issues Are Due to Spinal Cord Injuries

As many as 20% of couples struggle with infertility, and very few know there is a problem before they begin attempting to conceive a child. Even if your spinal cord treatment team gives you the go-ahead, you may have other issues that make conception difficult.

Most doctors recommend seeking help if you have not successfully conceived after a year. If you're over the age of 35, it's better to seek help after six months. While you're trying, some steps you can take to increase your odds of success include:

• Correctly timing intercourse: you are more likely to conceive if you time intercourse for just before ovulation and just after. Note that not all women ovulate on day 14 of their cycles, so counting might not help you increase your odds of success. 
• Using an ovulation monitor to predict ovulation. Note that it's possible to get a false positive on these monitors, so use them only as a tool, not as your only guide to your body. 
• Charting basal body temperature by taking the female partner's temperature every morning, before getting out of bed, at the same time each day. Immediately after ovulation, the temperature tends to slightly rise, helping you pinpoint when you ovulate. 

Overall Health Matters

Your overall health can affect your ability to conceive a child. Women, for example, tend to cease ovulating when they are malnourished or too thin. An active infection can undermine sperm and egg quality, making it more difficult to conceive and increasing the likelihood of an early miscarriage. Although there are no guarantees, the following strategies may help increase your fertility:

• Quit drinking alcohol, since there is no safe level of fetal alcohol exposure. Even dad's alcohol consumption can affect the baby. 
• Don't use illegal drugs or smoke cigarettes. 
• Eat a diet high in protein. If you are vegetarian, eat foods like nuts, legumes, and eggs. 
• If you are overweight, lose weight. Conditions like diabetes can greatly impede fertility. 
• Find ways to manage your stress. Stress can interfere with ovulation, but it may also reduce sperm quality. 
• Steer clear of pesticides and other known chemical toxins. Though you might not be able to fully rid your life of pollution and other dangers, minimizing your exposure as much as possible can slightly boost fertility while lowering the risk of birth defects. 

Artificial Reproductive Technologies Can Help

Even if you are unable to have intercourse or cannot get your partner pregnant, a number of other options are available. Those include:

• Intrauterine insemination: If the male partner has a low sperm count or doctors aren't sure why things aren't working, they might start with an IUI, during which the doctor inserts sperm directly into the uterus.
• In vitro fertilization: This approach merges sperm and egg outside of the body, increasing the odds of conception. If the man cannot ejaculate, the doctor may use electrostimulation to get the sperm. Alternatively, you and your partner might consider donor sperm.
• Hormonal treatments and other medications: If intercourse is going fine, there might be an endocrine system or other problem at play. Your doctor can treat this with hormonal treatments and some other medications.
• Surgery: Occasionally, physical issues such as uterine scarring, fibroids, or blocked fallopian tubes interfere with the ability to get pregnant.