Pregnancy and Fertility after Spinal Cord injury

Many couples wonder if they can get pregnant and have children after spinal cord injury.  Women have no change in their ability to get pregnant after spinal cord injuries but men have problems with both erectile dysfunction and ejaculation.  Even when ejaculation happens, the rate of pregnancy is only about 10 percent.  Sperm are less able to penetrate the egg during fertilization and the amount of ejaculate a paralyzed man can give is diminished.

Fortunately, there are good, newer technologies to help couples conceive a child after the man has had a spinal cord injury.  Babies born to paralyzed mothers have no greater risk of birth defects when compared to able-bodied women. Couples who choose to be parents after a spinal cord injury tend to do just as well as able-bodied parents.

As mentioned, men who have spinal cord injuries have fertility problems more so than women.  Team management of this problem is recommended using the services of a good urologist, a gynecologist, and an andrology lab worker who can prepare the semen for intrauterine insemination of washed and concentrated sperm.  Social workers can also be part of this fertility team.

Possible ways to get pregnant include intrauterine insemination as described above and in vitro fertilization.  Sperm can be gotten from vibratory stimulation using devices that stimulate ejaculation.  This is an inexpensive way to get pregnant but for those with T6 or higher lesions can develop autonomic dysreflexia upon vibratory stimulation of the penis.  Other men with spinal cord injuries have problems with retrograde ejaculation, in which the semen travels backwards to the bladder instead of outside.  There are specific vibrators used for men in this kind of procedure.  It is a decidedly unromantic way to have a baby but it is effective.  The ejaculate is collected in a sterile cup and then injected into the female vagina.  They can put the sperm on a diaphragm to help the sperm get up into the cervix better.

The quality of sperm is better with vibratory stimulation than with electrostimulation of the penis but the electroejaculation procedure is usually more successful.  It requires special equipment and possibly the taking of medication to keep the blood pressure down during the procedure.  You need two nurses to do the job.  One is necessary to milk the penis to get the ejaculate and the other monitors the patient’s blood pressure.  The woman is then inseminated with the ejaculate.

Some men cannot do electroejaculation because of nerve damage that normally aids in ejaculation.  In this type of situation, sperm must be collected from the vas deferens and then is inseminated into the woman.  There are problems of scarring and a lack of getting a lot of sperm but it does work in some cases.  Donor sperm can also be added to the man’s sperm to increase the chances of fertilizing an egg.

Sperm motility is usually low in spinal cord injured men.  Rather than the normal 60 percent motility, men with SCI have only about 5-10 percent motile sperm.   Men who self-catheterize have better sperm motility than men who have a chronic indwelling catheter.

Couples who use in vitro insemination can have success rates as high as 25 percent, depending on the facility.  It is an expensive procedure and not all insurance companies cover for it.  If traditional IVF fails, then intracytoplasmic sperm injections can be performed in which a single sperm is injected into a single egg.  This has success rates similar to regular IVF but it doesn’t need a great deal of sperm to be successful.

Pregnancy can be challenging for a woman with a spinal cord injury.  It is difficult for her to find an obstetrician who has dealt with paralyzed patients, for one thing.  There are a few more complications when dealing with a pregnant disabled patient but the risk of miscarriage, stillbirths, and preterm labor are no higher than with the rest of the population.

Women desiring pregnancy should have a thorough evaluation as to their overall health before they get pregnant. While pregnant, they need monitoring for the usual things a woman who is pregnant needs monitoring for.  She must be ready for all the changes that happen during pregnancy, just like a non-handicapped person should.  They need to use compression stockings and watch their fluid intake so as to avoid high blood pressure and they need to be aware of constipation due to pregnancy and inactivity.  She may be on medications that have to be stopped while pregnant.

Pregnant women who are paralyzed must watch out for excessive weight gain because they are inactive during the pregnancy and are more prone to indigestion and reflux disease.  Skin can break down during pregnancy and this must be watched for carefully.

Fully emptying the bladder is difficult for the pregnant woman.  For this reason they need to catheterize more often and keep particular care in preventing bladder infections.  They need to drink plenty of fluids to flush out the bladder and try vitamin C or cranberry supplements to prevent bladder infections from occurring.

Blood clots are more common in pregnancy and they are especially dangerous in women who are paralyzed and for whom blood flows slowly in the legs.  Some women require heparin to get rid of blood clots during pregnancy. Antispasmodic medication needs to be stopped during pregnancy, which means that spasticity can be a problem.

One of the most challenging parts of being pregnant while paralyzed is that the woman may not know when she is in labor.  Lesions below T10 will feel some degree of contractions, while others will just notice abdominal tightening or a back ache.

Some doctors recommend that a woman at term be hooked to a rented monitor at home so that she can detect contractions while still at home.

Autonomic dysreflexia is a concern for women in labor who have lesions at or above T6. Because of this, doctors prefer induction of labor in these patients so they can be monitored for the condition.  Short acting medications to lower blood pressure in labor may be necessary.  Rarely is forceps needed to get the baby out and even high level injuries do not prevent the safe passage of the fetus through the birth canal.  Most paralyzed women have atrophy and elasticity of the perineum so that they don’t need episiotomies as often as non-paralyzed women.

Overall, pregnancy, labor and delivery are not much different when compared to able-bodied persons.  Patients need only get a good obstetrician, watch out for an increase in bladder infections and pressure sores and be prepared for the fact that they may not feel the early contractions in labor.  

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