Assisted Reproductive Technology for Fertility Following Spinal Cord Injury
Written by Ben Bunting: BA(Hons), PGCert.
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A spinal cord injury can affect many aspects of a woman's life, including her fertility and sexuality. Her capacity to reproduce can be greatly impaired, and she may experience difficulties with pregnancy and awareness of labor. She may also experience problems with ovulation and awareness of labor. A doctor may recommend assisted reproductive technology to improve her chances of pregnancy.
Assisted reproductive technology
Assisted reproductive technology for fertility following spinal cord injuries is an option for individuals who are unable to conceive naturally due to a spinal cord injury. The treatment options include electroejaculation (EEJ) and in-vitro fertilization (IVF). In-vitro fertilization is the method of choice for men unable to conceive naturally because of their SCI.
However, the success rate of assisted reproductive technology in the treatment of SCI is still low. Although it is the most expensive and invasive assisted reproductive technology available, it is recommended as a last resort for couples who cannot conceive naturally. The sperm yield is extremely low with these techniques and patients are often committed to costly and invasive procedures.
Advances in physical therapy and medicine have increased the desire of patients with SCI to start a family. However, the overwhelming majority of men are unable to conceive biologically without medical assistance. Male infertility is often caused by several contributing factors, including erectile dysfunction and abnormal semen. Fortunately, most women are able to retain their fertility and conceive a child. However, they may experience intermittent amenorrhea and may need close monitoring throughout the pregnancy.
Electroejaculation
Electroejaculation for fertility following spinal-cord injury is a form of assisted reproductive technology, which can be performed under the supervision of a physician. It can improve a man's chance of conceiving. The technique requires simultaneous access to the rectum and penis. Several factors can contribute to poor quality of the semen produced during electroejaculation, including prolonged abstinence, antisperm antibodies, and reactive oxygen species. In addition, there is no definitive cure for poor semen quality after electroejaculation and advanced fertility techniques are needed.
In one study, electroejaculation led to pregnancy in a man with spinal cord injury. The procedure was performed on 27 patients. Ten percent of the men had at least some ejaculate, while the other twenty-five percent did not produce any. Although electroejaculation is an invasive procedure, the procedure was associated with few complications. A median total motile sperm count of five ten six was achieved by 38 electroejaculation attempts and one live birth.
Generally, most men with a SCI do not have antegrade or retrograde ejaculation during intercourse. They have to be assisted by medical professionals to retrieve sperm. To produce a normal ejaculate, the spinal cord needs to be intact in T11-S4 levels. A medical grade vibrator is applied to the ventral or dorsal surface of the penis for two to three minutes.
While electroejaculation does not guarantee successful implantation, it can dramatically improve a man's sperm quality and increase his chances of conceiving. In addition, men with SCI often have low sperm count due to abnormally toxic seminal plasma.
Vibratory stimulation
Vibratory stimulation is a treatment option for men suffering from spinal cord injury who are unable to father children naturally. It combines the use of a vibrator with vaginal self-insemination to stimulate ejaculation. This treatment has been reported to help anejaculatory men achieve pregnancy. The method is safe and inexpensive, and can be combined with other forms of assisted reproductive techniques. However, further research is needed to better understand the effectiveness of this treatment and the rate of pregnancy.
The severity of the spinal cord injury will determine whether vibratory stimulation will help a man become fertile. This treatment can increase sperm viability and motility. The quality of the sperm is also important. In men who are undergoing treatment for infertility after a spinal cord injury, abnormal sperm counts can contribute to infertility. The Men's Clinic at UCLA has experts in this field who can help men improve their chances of having a child.
Vibratory stimulation for fertility after spinal cord injuries is a non-invasive treatment option. PVS is performed by attaching a medical-grade vibrator to the dors or ventral surface of the penis. The vibrator is positioned over the penile nerve for two to three minutes.
In ten percent of SCI patients, a sexual relationship can resume naturally, although the chances are low. Other options include prescription medications, urethral suppositories, and vacuum erection devices. If these treatments fail, men may need to undergo surgery to improve their fertility. In severe cases, penile implants are an option for men who fail to respond to conservative treatments.
Men with SCI may benefit from sperm retrieval assisted reproductive techniques. Though men with SCI often have impaired semen quality, assisted reproductive techniques allow them to achieve biological fatherhood. Penile vibratory stimulation (PEVS) is a relatively safe and effective method of sperm retrieval. It produces an ejaculate in eight percent to ninety percent of patients. And 75% of the ejaculates produced by these patients had more than five million motile sperm.
Sperm quality
The quality of sperm in men following spinal cord injury can vary widely. Some of the factors that contribute to a lower sperm quality after spinal cord injury are a lack of motility, abnormal morphology, and an increased number of WBC in the ejaculate. However, the cause of poor sperm quality following spinal cord injury is unknown. Researchers speculate that the cause may be related to a number of factors including stasis of prostatic fluid, infection of the urinary tract, or changes in hypothalamo-pittesticular axis.
One possible cause of poor sperm quality in men following spinal cord injury may be the lack of follicle-stimulating hormone. However, this hormone is inconsistent in patients with SCI and is unlikely to be the major contributor to poor semen quality in men. Regardless of the cause, understanding the natural history of sperm abnormalities in men following SCI will help clinicians and researchers better understand the problem and develop clinical strategies to improve it.
Men with SCI usually have abnormal sperm quality, motility, and viability. Although the cause of abnormal sperm quality is unknown, recent studies suggest accessory gland dysfunction as a potential culprit. Most SCI patients show leukocytospermia, or low sperm counts. Neutralization of pro-inflammatory cytokines and inflammasome components has also been linked to improved motility. Most couples undergoing SCI undergo surgical sperm retrieval as their first option.
Getting a full fertility workup after spinal cord injury
Getting a full fertility workup after a spinal cord injury is extremely important if you are considering trying to conceive. There are many factors that can affect fertility, including spinal cord injury, but getting a full fertility workup can be helpful for both men and women. If you are considering getting pregnant after spinal cord injury, a fertility specialist can help you find the right treatment plan.
For men with spinal cord injuries, abnormal sperm is a potential cause of infertility. While the numbers of sperm are usually normal, their motility and viability are low. A full fertility workup can help determine the best way to retrieve sperm for IUI or IVF.
A full fertility workup after spinal cord injury will include a comprehensive assessment of the male and female reproductive health. The urologist will recommend fertility treatments that may help the couple get pregnant. In addition, the urologist can provide help for men with spinal cord injuries with male infertility.
Many clinician teachers state that SCI has no effect on female fertility. However, there are no studies that compare the fertility of women with SCI to a control group without spinal cord injury. Such studies, as well as prospective cohort studies, could help provide important natural history information for women suffering from SCI. The goal of fertility treatment is to increase the chances of ovulation. If the ovulation is increased, the chances of pregnancy are high.
Conclusion
Assisted Reproductive Technology (ART) involves major physical, emotional, and financial commitments for patients. Couples often have high expectations. Unfortunately, many ART treatments fail in a given cycle, which can leave couples feeling frustrated, isolated, and low in self-esteem. Support from loved ones and friends is essential during these difficult times. Psychological counseling may also be needed for patients and couples.
In vitro fertilization (IVF) is the most common assisted reproductive technology used today. The process involves collecting oocytes from the ovary and fertilizing them in a laboratory. It also involves embryo culture, embryo transfer, and preimplantation genetic testing. IVF can also be performed with the help of a gestational carrier or donor eggs. If IVF fails, patients can also opt to freeze extra embryos for later use.
