After a spinal cord injury (SCI), most men are unable to ejaculate and thus unable to impregnate their partner, but there are other ways to assist with a pregnancy
In the United States (US), the annual incidence rate of traumatic SCI is about three people per 100 000. Males
are affected five times as often as females, and the average age at onset is said to be 29 years. There are unfortunately no accurate statistics in South Africa but we are likely to have similar injury rates, age and sex statistics.
With the majority of persons suffering a SCI being young and male, many questions are raised about fertility issues. In a previous article I spoke about erectile dysfunction and the solutions for this problem, but I would like to focus now on fertility. Many patients ask me about fertility and the possibility of having children one day.
First, note that SCI does not affect fertility in the female. It is common, after an injury, for a woman to experience a loss of the normal menstrual
cycle for a while, but normal cycles do return. Therefore, the ability to fall pregnant also remains unchanged.
However, for a SCI male, the situation is different. The first challenge is the inability to ejaculate. Only a very small percentage of SCI men are still able to ejaculate and impregnate their partner. The majority of SCI men are unable to ejaculate normally and should therefore seek help. The following solutions are available.
For higher-level injuries, reflex ejaculation is possible. This can be achieved through the use of a vibro ejaculator. There is an excellent video on YouTube, where Dr Stacey Elliot demonstrates the use of the Ferticare.
For those who want to buy their own device, they are available online from a Danish supplier
(www.multicept.dk) or locally from the medicalvibrator.co.za site. Essentially, the device stimulates the penis using specific amplitude and frequency, enabling reflex ejaculation in certain individuals.
The sperm obtained can then be collected and used to inseminate one’s partner. This is the cheapest and easiest way of obtaining sperm. Some SCI clinics may have their own Ferticare devices and you should contact your spinal injury follow-up clinic to enquire. Of course, timing of insemination is vital but this is a topic all on its own.
Remember that this procedure can cause severe autonomic dysreflexia, so if you do suffer from AD, consult your doctor first. If reflex ejaculation is not possible, remember that sperm can always be obtained through other means. This would involve the direct removal of sperm from the testis.
This small procedure is usually done at a fertility clinic. Once sperm is obtained they can be used to fertilise an egg – a process known as ICSI. This is however an expensive path to take. Speak to your fertility clinic for further information. These services are also available in the larger state hospitals.
Dr Ed Baalbergen is the medical officer at the Vincent Pallotti Rehabilitation Centre (Cape Town) and is a member of the International Spinal Cord Society and the Southern African Neurological Rehabilitation Association. email: firstname.lastname@example.org