Disclaimer: The content contained in this post may be graphic and not suitable for all ages… or for reading at work. Reader discretion is advised!
Also, to our parents… you might want to stop here!
We said one day that we would talk more about sex and babies. Well friends, that day has come! Since one of us is pregnant and the other one is hoping to become pregnant, we thought now was as good a time as any to involve you in our pregnancy journey. First things first, we need to lay down the basics, Let’s start with a spinal cord injury sex-ed lesson, shall we?
We all know (or we all should know by now) that to get pregnant naturally the woman needs to be at the right point in her cycle and the man needs to get an erection and ejaculate… the birds and the bees right? Well, spinal cord injuries can interfere with the ability to do that. Fertility issues are common in men with SCI for several reasons:
- Erectile dysfunction. There are two types of erections; reflexogenic, which occurs with direct stimulation of the penis and doesn’t need any input from the brain, and psychogenic which happens when the brain transmits sensory input from sights, sounds and smells down the spinal cord to the nerves that control erections (T10-L2). Depending on the level of injury, that sensory input from the brain may be blocked from reaching those nerves, leading to difficulty obtaining and maintaining an erection.
- Anejaculation. This is the inability to ejaculate during sexual intercourse and affects 90% of men with spinal cord injuries.
- Poor semen quality. Men with SCI make normal amounts of sperm, but only 20% of those sperm are motile, compared to 70% in able bodied men.
There are many different ways to improve, treat or work with each of these issues. Erectile dysfunction is most commonly treated with oral medications such as Viagra or Cialis, but can also be treated with medications that are inserted into the urethra or injected directly into the penis. Other options include penile implants and vacuum erection devices, or penis pumps.
Because an SCI causes disruption in the nerve pathways to and from the brain, many men are unable to respond to the normal stimuli during sex that results in ejaculation. The reflex pathways, however, don’t require that input from the brain so ejaculation is still possible through artificial stimulation.
- Penile vibratory stimulation (PVS). Applying a vibrator to the head of the penis is a common way for men with SCI to achieve ejaculation. About 85% of men are successful with this and are able to do it at home. There are a ton of different vibrators available ranging from low amplitude, relatively inexpensive ones like the Magic Wand to high amplitude, pricey ones like the FertiCare.
- Electroejaculation. When PVS fails, a medical professional can insert an electrical probe rectally to induce ejaculation.
- Prostate massage. Exactly what it sounds like. A medical professional uses a finger inserted into the rectum to massage the prostate gland and manually produce ejaculate. This method doesn’t work for everyone and generally has a low sperm yield.
- Surgical sperm retrieval. When any of the above methods are unsuccessful, surgery is an option. There are a few different ways to surgically retrieve sperm and you can talk to your doctor about the option that is best for you and your situation.
After you’ve figured out ejaculation and how to get your sperm, you can go about the business of getting pregnant! The methods for insemination are the same as they would be without an SCI.
- Intra-vaginal insemination (IVI). This can be done at home and involves collecting the semen and inserting it into the vagina manually.
- Intra-uterine insemination (IUI). This is done in a laboratory where they separate the sperm from the semen and a doctor uses a catheter to place the sperm into the woman’s uterus when she is ovulating. A sperm count of at least 5 million is needed for this to be successful.
- In-vitro fertilization (IVF). For IVF, a woman’s eggs are removed and mixed with the sperm in a lab. They are left for 3 days while fertilization takes place and then placed into the uterus. A sperm count of a few hundred thousand per egg is needed for this to be successful.
- Intracytoplasmic sperm injection (ICSI). This method involves a single sperm being injected directly into a single egg. They are left until fertilization is confirmed and then placed in the uterus. ICSI is generally only used when sperm count doesn’t meet the numbers needed for IVF.
Still with us? Well, if we haven’t lost you yet, then we promise it’s going to get better… and less medical! Each couple with an SCI will have a different fertility/pregnancy journey and being that we are both able bodied females with men in chairs, we can only speak to what we know. So, for
now we will give you a break to digest all that medical nonsense, but check back next week and we will delve into our personal pregnancy stories! It’s time to get intimate =)
Sam & Chelsea
For more information check out: http://www.themiamiproject.org/wp-content/uploads/2015/07/male-fertility-booklet-2010-lowres.pdf