Studies have shown that only around 10% of men with spinal cord injuries are able to conceive naturally through intercourse. Thankfully for the other 90% there are a myriad of options, each with varying levels of invasiveness, effectiveness and potential side effects.

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Vibratory Stimulation

Vibratory stimulation is the most common method families try first. It involves applying a vibrator like the Viberect or Ferticare to the penis in hopes of achieving ejaculation. “They gave us the option to do it in the clinic, but we preferred to do it at home,” says Max Woodbury, a C6 quad from a fall at work in 1996 when he was 24.” He and his wife, Tali, had success with Ferticare, but it came with terrible autonomic dysreflexia. “It was kind of scary, because the headache was so intense. Way more than I’ve ever had from bowel or bladder [irritation].”
Collected semen can be used for artificial insemination, but because low motility is so common for men with SCI, many couples choose to use it for the in vitro fertilization method of selecting one good sperm to be injected into each egg. ”We tried artificial insemination half a dozen times before we were ready for IVF,” says Woodbury.

Electroejaculation

Woodbury’s Portland Pounders Quad Rugby teammate, Ed Suhr, hadn’t had much luck with Ferticare when he and his wife, Trish, tried it in 2003. “Nothing was coming out,” says Suhr, a C5 quad since a 1984 car accident. “Either it wasn’t happening, or it was retrograde.” Retrograde refers to backward ejaculation into the bladder, another common phenomenon for men with SCI. In those situations, the sperm must be retrieved from the urethra or bladder and washed with a chemical solution before being used for fertilization.

The couple was advised to try electroejaculation, where an electric probe is inserted into the rectum and positioned against the prostate to stimulate ejaculation by slowly increasing the frequency and amplitude of energy to the probe. The procedure is not as widely used these days because it carries a risk of rectal mucosal burns and awful autonomic dysreflexia. “That was kind of a nightmare,” says Suhr, of his dysreflexic response. He thinks his blood pressure was 280/130. “We didn’t try that again.” One unsuccessful attempt was all he needed to move on to surgical options.

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Testicular Sperm Aspiration

Any mention of surgery and testicles in the same sentence is enough to make even a paralyzed man’s legs spontaneously spasm closed. “It sounds like the doctor carves out a part of your testicle and then holds it up in a glass vial, saying, ‘See this?’ Tink, tink, tink,” says Woodbury about TESA.

“The reality is a lot less graphic,” says Ian Ralston, a former Army medic and C1 quad from a 2010 IED attack in Iraq. When he and his wife, Nicole, were looking to have kids in 2014, they settled on TESA to get the job done.

The minimally-invasive procedure is akin to a biopsy, where tissue and fluid are extracted from the testicle by using a needle with negative pressure. “They didn’t put me under, they just gave me a couple of units of Versed that knocked me out really quick,” says Ralston about the 30-minute procedure he underwent in 2014 that netted six vials of bankable sperm for later use.

Results can vary because of the blind nature of the biopsy. That is probably why I came to think of the TESA as trying to extract loose change from your couch by shoving the extension wand of your vacuum in between the cushions.

Microscopic Testicular Sperm Extraction

Compared to TESA, microscopic testicular sperm extraction has significantly higher sperm retrieval rates. Also it is a safer procedure since less tissue is removed. The MicroTESE method is performed in an operating room, where a doctor makes a small incision in one or both testicles and uses a high-power microscope to identify and extract specific tubules that appear swollen and may contain sperm. Ed Suhr has much better memories of the microTESE than the electroejaculation. “It was a pretty simple procedure and I recovered within a couple days.”

When it comes to sperm retrieval advice, Woodbury says it’s the proverbial different strokes for different folks. “You try to be as easy and natural as possible, and if that doesn’t work, move on to the next step, and the next, and so on.” NOTE: Be sure to consult with your doctor about which method might work best for your situation.

See Also:
Our In Vitro Fertilization Journey to Parenthood

Double Trouble: The Embryo Transfer Gamble