The impact of spinal cord injury on male fertility

What is the spinal cord?

The spinal cord is bundle of nerve tissue inside the backbone. This nerve tissue is responsible for transmitting signals between your brain and your body. When you move your arm to pick up a glass, and when you feel the cold glass in your hand, those signals are going through your spinal cord.

Why would spinal cord injury cause infertility?

Your reproductive organs also receive signals from, and send signals to, your brain. These signals are necessary for normal sexual and reproductive function. If a spinal cord injury damages these nerves, then the injury can cause infertility. There are many factors that can influence whether or not a spinal cord injury is causing infertility. In some cases, a neurologist or neurosurgeon may need to help your doctor determine if your injury is contributing to infertility.

How does spinal cord injury impact a man’s fertility?

Spinal cord injury impacts a man’s fertility in two ways. First of all it can disrupt the nerves signal that are needed to get an erection, have sex, and cause ejaculation. Ejaculation is necessary to deposit the sperm into the vagina.

Second, men with spinal cord injuries have worse sperm quality than men without spinal cord injury. Signs of inflammation in the testicles, poor sperm movement, and a lower number of live sperm are more common in men with spinal cord injury. The reasons for these differences in sperm quality are still being investigated.

What options are available to treat infertility in men with spinal cord injury?

The best options to cause a pregnancy after spinal cord injury depends on a man’s sexual and reproductive function after the injury. Your doctor will work with you to identify which options are appropriate for you and if it is a good idea to freeze sperm for future use. You should speak with your doctor about the risks of autonomic dysreflexia – a potentially life-threatening complication – before starting any treatment for sexual dysfunction or infertility.
The options for creating a pregnancy after spinal cord injury may include:

Natural pregnancy: Men who can get an erection and ejaculate into their partner’s vagina may be able to cause a pregnancy on their own. Because sperm quality is poorer in men with spinal cord injury, it may take longer to get pregnant naturally and a fewer couples may get pregnant naturally.

Vibratory stimulated ejaculation: Men with certain spinal cord injuries may be able to cause ejaculation by applying vibration to the penis. The ejaculated specimen can then be used to cause a pregnancy. Depending on the quality of the sperm, it may be used for at home intravaginal insemination or for assisted reproductive techniques such as intrauterine insemination, in-vitro fertilization, or intracytoplasmic sperm injection.

Electro ejaculation: The nerves that signal ejaculation can be directed stimulated by electrodes temporarily placed in the rectum and near the seminal vesicles. This treatment is done by a doctor and some patients will need to have an anesthesia provider put them to sleep. Depending on the quality of the sperm, it may be used for assisted reproductive techniques such as intrauterine insemination, in-vitro fertilization, or intracytoplasmic sperm injection.

Collecting sperm from the urine: Some men may ejaculate into the bladder and in these men the sperm may be found in the urine. Because urine is a hostile environment for sperm, it is frequently necessary to take medication or put sperm friendly media into the bladder to increase the number of usable sperm in the urine. Depending on the quality of the sperm, it may be used for assisted reproductive techniques such as intrauterine insemination, in-vitro fertilization, or intracytoplasmic sperm injection.

Sperm retrieval surgery: Spinal cord injury does not stop all sperm production by the testicles. Sperm can be extracted from the testicular tissue in many men with a injury. Common techniques to get testicular tissue include aspirating tissue with a small needle, removing a core of tissue using a larger needle, and opening the skin to get tissue directly from the testicle. In some cases, these procedures are done in an operating room. The tissue is then examined under a microscope to identify and separate the sperm from the other cells. Sperm retrieved through surgery can be used for intracytoplasmic sperm injection.