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What It Takes to Become A Father after SCIby Phil Klebine, MA
Many men with spinal cord injury (SCI) and their partners want to have children after injury. In fact, there are some couples that have little or no difficulty achieving pregnancy. However, most men with SCI have problems with either sexual functioning, fertility, or both. These problems must be solved if couples are ever to become parents. The Miami Project to Cure Paralysis has published "A Guide and Resource Directory to Male Fertility Following Spinal Cord Injury/Dysfunction." It is a 44-page booklet and serves as an excellent source of information for both men with SCI/D and their partners. It discusses potential obstacles in achieving pregnancy and ways that couples can overcome those obstacles and become parents after injury. This article is a brief overview of that booklet. Erectile Function An erection occurs when blood flow increases to the penis causing it to become stiff, or erect. Normally, two types of sexual stimulation cause erections. Psychogenic erections occur when the brain reacts to sights, smells, and sounds of sexual activity. The brain sends signals through the spinal cord to produce an erection. Reflexegenic erections occur in response to direct stimulation of the penis and without input from the brain. Men usually get an erection through a combination of both psychogenic and reflexegenic stimulation. The purpose of an erection is to engage in sexual activity. The ability for men with SCI to have and maintain an erection is different for each person. It can depend on the level of injury and whether the injury is complete or incomplete. Many men with SCI can no longer have psychogenic erections as a result of the injury to their spinal cord. However, some men do retain their ability to have reflexegenic erections after injury and have no problem engaging in sexual activity. Others have reflexegenic erections that only last a short time, or their erection is not stiff enough to allow for sexual intercourse. Finally, some men lose their ability to have both psychogenic and reflexegenic erections after injury. It is important for men with SCI to solve their problems with erectile function even if they do not want to have children. Several treatment options are available that can help them have and maintain erections. Viagra® (sildenafil citrate) is a pill that is taken to help men have an erection. It is typically taken between 20 and 60 minutes before sex. Viagra helps to open blood vessels allowing increased blood flow into the penis. Studies have shown that up to 75% of men with SCI report an improvement in the ability to have an erection using Viagra. Injectable Medications, such as Caverject®, can be effective in allowing men to quickly have an erection. The medication is injected through a syringe and needle into the penis. The erection occurs when blood vessels open to allow the penis to fill with blood. A Vacuum Device is a cylinder with an attached vacuum pump. The cylinder is placed over the penis and air is drawn out of the cylinder by the pump. This process pulls blood into the penis to produce an erection. A tension ring is placed at the base of the penis to maintain the erection. Penile Implants are also available. These devices are surgically inserted in the penis. Implants usually consist of an extending chamber within the penis. A water reservoir may then be used to pump water into the chamber to produce an erection. Ejaculatory Function Ejaculation is the process of delivering semen from the urethra through the penis. Semen contains sperm, which are needed to achieve pregnancy. The brain normally sends signals through the spinal cord and coordinates the ejaculatory process with the erection. Although most men with SCI can have erections either naturally or through other options, about 90% of men with SCI are not able to ejaculate on their own. This is a problem for those men who want to be fathers. If they cannot ejaculate during intercourse, they must rely on alternative methods to induce ejaculation. Masturbation is the stimulation of the penis with the hand or other method. Masturbation may result in ejaculation for men with SCI because the stimulation can be more intense than sexual intercourse. Penile Vibratory Stimulation (PVS) is a vibrating device used for masturbation. Studies show PVS is relatively effective in inducing ejaculation for 60 to 80% of men with T10 levels of injury and higher. If masturbation is not succussful in producing ejaculation, men with SCI who want to become fathers may find success with Rectal Probe Ejaculation (RPE). RPE is done by a doctor and can induce ejaculation for many men with SCI. This method requires the insertion of an electrical probe into the rectum to stimulate ejaculation. If RPE is not successful, doctors can surgically retrieve sperm directly from the man's reproductive tract. Potential Problems Men with SCI should always consult a doctor familiar with SCI/D and its effects on fertility before trying any treatment option. Medications like Viagra and Caverject can have serious and sometimes life-threatening effects. Autonomic Dysreflexia (AD) is a life threatening condition and can be a major concern for men with SCI trying to induce ejaculation. Some men may also face other medical problems unique to men with SCI. Retrograde ejaculation is one such problem. This occurs during ejaculation when the semen enters the bladder instead of exiting through the penis. Semen quality is also a major concern for men with SCI. Semen quality describes the sperm within the semen. Normally, men produce a large number of sperm during ejaculation. For most men, about 70% of the sperm they produce are considered motile. Motile sperm are alive and very active. The greater the number of motile sperm, the greater the chances are for achieving pregnancy. Graph 1 shows that semen of men with SCI usually contain a normal number of sperm, but the sperm have low motility. This means that most of the sperm are not active. Graph 2 shows that only about 20% of sperm from men with SCI are considered motile compared to about 70% of sperm from able-bodied men. Getting Pregnant Pregnancy results when the sperm from a man fertilizes the egg from a woman. This fertilization process typically begins during sexual intercourse as the sperm is ejaculated into the woman's vagina. The motile sperm then move through the cervix, uterus, and into the fallopian tubes to fertilize the egg. Because many men with SCI are not able to ejaculate during sexual intercourse, they and their partners should be informed of other methods that may be necessary to achieve pregnancy. Some couples may find success in achieving pregnancy with in-home insemination if masturbation or RPE can induce ejaculation. This process involves collecting semen to be drawn into a syringe without a needle; the syringe is inserted into the vagina; and the semen is squirted into the vagina near the cervix. If in-home insemination is not successful, couples can choose from other medically assisted procedures to achieve pregnancy. One procedure requires doctors to separate the sperm from the semen and insert the sperm into the uterus. This process is called Intrauterine Insemination (IUI). This procedure improves the chances of the sperm traveling into the fallopian tubes to fertilize the egg. Other medical procedures involve fertilizing the egg outside the woman's body. After fertilization occurs, pregnancy is achieved through either In vitro Fertilization, Gamete Intrafallopian Transfer, Blastocyst Transfer, or Intracytoplasmic Sperm Injection. Conclusion It is important for men with spinal cord injury and their partners to know that they may face challenges in achieving pregnancy. Those challenges may be with erectile function, ejaculatory function, AD and/or low semen quality. In fact, there is simply no way to predict what, if any, challenges men with SCI and their partners may face in achieving pregnancy. However, there are options available to overcome those challenges. It may take time, and there is no guarantee for success. But couples that work together can become parents. This article includes content taken from "A Guide and Resource Directory to Male Fertility Following Spinal Cord Injury/Dysfunction" by Maria J. Amador, BSN, CRRN, Charles M. Lynne, MD, Nancy L. Brackett, PhD, HCLD. It is a publication funded by the Paralysed Veterans of America SCI Education and Training Foundation. To recieve a copy of this booklet, contact: The Miami Project to Cure Paralysis
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