For many men who have experienced paralysis, having biological children is a hopeful reality. Medical advancements and specialized reproductive techniques offer various avenues for individuals to achieve fatherhood. These developments provide opportunities for couples to build their families, even with the challenges associated with paralysis.
Understanding Fertility After Paralysis
Spinal cord injuries (SCI) and other forms of paralysis can significantly impact male fertility, primarily affecting the ability to ejaculate and, in some cases, sperm quality. Ejaculatory dysfunction is a common issue, where nerve damage disrupts the complex coordination required for natural ejaculation. This means that while sperm production continues, its release may be impaired or absent. Only a small percentage of men with paralysis can ejaculate through masturbation.
Beyond ejaculatory challenges, sperm quality can also be affected. Men with SCI often exhibit normal sperm concentrations but experience low sperm motility and viability. Factors such as recurrent urinary tract infections, issues with temperature regulation in the scrotum, and the type of bladder management used can contribute to these changes. For instance, men using indwelling catheters may have lower sperm motility rates, around 5%, compared to those who intermittently catheterize, who might see rates around 27%.
Methods for Sperm Retrieval
When natural ejaculation is not possible, several medical techniques can retrieve sperm for assisted reproduction.
Penile Vibratory Stimulation (PVS)
Penile vibratory stimulation (PVS) is a non-invasive method that applies a specialized vibrator to the head of the penis to stimulate a reflex ejaculation. This technique is effective for men with higher levels of spinal cord injury (T10 or above), achieving successful ejaculation in approximately 86% of cases.
Electroejaculation (EEJ)
If PVS is unsuccessful or not suitable, electroejaculation (EEJ) is another common procedure. This involves the controlled delivery of electrical stimulation to nerves near the prostate and seminal vesicles, prompting ejaculation. EEJ is often performed under anesthesia to manage potential discomfort and autonomic dysreflexia, a sudden increase in blood pressure that can occur in men with injuries at T6 or above.
Surgical Sperm Retrieval
In situations where PVS and EEJ do not yield sufficient or viable sperm, surgical sperm retrieval methods may be considered. These more invasive options include Testicular Sperm Extraction (TESE) or Percutaneous Epididymal Sperm Aspiration (PESA). TESE involves taking small tissue samples directly from the testicle, while PESA aspirates sperm from the epididymis, the tube where sperm mature and are stored. These techniques are typically reserved as a last resort.
Pathways to Conception
Once sperm has been retrieved, various assisted reproductive technologies (ART) can be employed to achieve pregnancy.
Intrauterine Insemination (IUI)
Intrauterine Insemination (IUI) involves concentrating the retrieved sperm and directly placing it into the female partner’s uterus around the time of ovulation. This method is considered when sperm quality is good and the female partner has no underlying fertility issues.
In Vitro Fertilization (IVF)
In Vitro Fertilization (IVF) is an option for more advanced intervention. In IVF, eggs are retrieved from the female partner and fertilized with the retrieved sperm in a laboratory. The resulting embryos are then cultured for a few days before transfer into the woman’s uterus.
Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic Sperm Injection (ICSI) is a specialized technique often used with IVF, particularly beneficial for men with paralysis. With ICSI, a single sperm is directly injected into an egg. This is useful when only a small number of motile sperm are available or if sperm motility is low. This method significantly improves fertilization chances even with compromised sperm quality.
Key Considerations for Parenthood
Parenthood after paralysis involves several important considerations beyond technical procedures. Consulting with specialists experienced in spinal cord injury and male fertility is recommended. This includes reproductive urologists, fertility specialists, and reproductive endocrinologists who can provide tailored advice and manage potential complications.
The female partner’s reproductive health is also a significant factor in the success of fertility treatments. A comprehensive evaluation of her fertility status ensures any potential issues are identified and addressed, maximizing conception chances.
Managing the man’s overall health conditions related to paralysis is important. This includes bladder management strategies, prevention of urinary tract infections, and awareness of autonomic dysreflexia during procedures. Maintaining general well-being can positively influence the success of fertility treatments.