How Can a Spinal Cord Injury Affect Fertility?

If you’re considering having children after a spinal cord injury, you may have questions about how your fertility has been affected. You may be wondering if it’s possible to get pregnant (or make your partner pregnant), and if it’s safe to try and have a biological baby after a spinal cord injury.

The short answer: yes, and yes!

How many people become a parent with a spinal cord injury?

Just how many people with SCI become parents? It’s not easy to find statistics, but we do know that spinal cord injuries often happen during the childbearing years. A small 2018 survey of Dutch people with SCI (all of them wheelchair users) found that 50% of the men and 45% of the women were parents, in most cases having children after their SCI and not before. The rate is lower than the 74% of men and 81% of women in the general population who become parents. But it shows that a significant number of people do go on to have babies after their spinal cord injury.

How does a spinal cord injury impact fertility?

This doesn’t mean a spinal cord injury has no impact on fertility. But it affects men and women very differently. For instance:

• Women may miss a few periods immediately after their injury. They then go on to have completely normal fertility, and in most cases are able to deliver vaginally.
• Men may have normal sperm for the first couple of weeks post-injury. After that, they have reduced quality of sperm; however, it doesn’t keep worsening over time. (Fun fact: It used to be assumed that all that time sitting in a wheelchair was overheating the scrotum and damaging sperm. Not true!)

Even though a woman’s fertility isn’t usually affected long-term by her spinal cord injury, there are other challenges she may face:

• Around one in eight women will have trouble getting pregnant, regardless of a spinal cord injury. The reproductive therapies available to women with SCI are the same as those used in the general population.
• The pregnancy itself can cause problems such as UTIs, autonomic dysreflexia, spasms and pre-term babies, so it’s important to talk with a healthcare provider and have strategies in place to deal with these issues.

Happily, women with SCI who get pregnant don’t have any increased risk of severe outcomes or hospitalization compared to the general population.

For men with a spinal cord injury, there are a few ways fertility can be affected. It depends on the level of injury and whether or not it’s complete, but in general:

• Their semen quality is often poorer – there are fewer motile sperm (i.e. good swimmers).
• They may have trouble getting or keeping an erection.
• They may no longer ejaculate the way they did before their injury. Either they don’t ejaculate at all, or when they do, it goes backwards into the bladder. (This experience is called retrograde ejaculation.)

What can you do to improve your fertility when you have a spinal cord injury?

Fortunately, there are strategies to overcome all of these issues, and a urologist who specializes in SCI can help. While some methods are high-tech and require medical assistance, others are low-tech and can be used at home!

• Some men can ejaculate into a cup when a high-amplitude (high-intensity) vibrator is held against the head of their penis. They can then use a syringe to inseminate their partner.
• Men with retrograde ejaculation may find that certain medications, such as antihistamines, will hold the bladder neck closed and keep sperm from going backwards.
• A doctor may be able to stimulate ejaculation by applying a gentle electrical current to the prostate.
• Sperm can also be collected surgically or with a needle.

Be aware that any sperm retrieval can trigger autonomic dysreflexia – but your doctor can suggest medications to take beforehand that will control it.

Does birth control make more sense for you?

What if you’re not interested in having children right now? Here are a few tips for birth control:

• If you’re female, condoms might be the best choice, as there can be complications associated with IUDs and birth control pills. Speak with your healthcare practitioner about the right option for you.
• If you’re male and you don’t ejaculate like you used to do, you’re not off the hook! It’s still possible to release sperm when you’re aroused. Don’t assume you don’t need any birth control.
• Of course, having a spinal cord injury won’t stop you from contracting sexually transmitted diseases… that’s one more reason it’s important to practise safe sex.

Quick links:

1. https://www.frontiersin.org/articles/10.3389/fresc.2022.853647/full

2. https://pubmed.ncbi.nlm.nih.gov/29352157/