Fertility & Spinal Cord Injury

Recently issues relating to family planning and fertility in clinical negligence claims have come under renewed focus following the decision in Whittington Hospital NHS Trust v XX [2020] UKSC 14.  A welcome decision that evidenced the courts are willing to make decisions reflective of changing public attitudes to alternative family planning, in that case the Supreme Court upheld the decision to allow a Claimant to claim for the costs of commercial surrogacy.

Following this decision my colleagues in the Spinal Injury team have commented both on the case and also on considerations for pregnant women who are also living with a spinal cord injury (“SCI”).

From my experience working within the Spinal Injury team it seems to be a recurring topic that issues relating to fertility and coitus are often less discussed and there is a real lack of accessible information.  As a reflection of this there are many misconceptions in the general populace surrounding this topic – I myself readily acknowledge that before working in the Spinal Injury team I was previously ignorant of much of what I now include in this blog. 

As mentioned above, my colleague recently commented on fertility in women with spinal cord injury.  Of note it is often a misconception that women who are spinal cord injured are either not able to bear their own children or, are infertile.  In fact for almost all women with a spinal cord injury this is not the case and they can fall pregnant and child bear the same as any other woman; albeit there are some secondary considerations to appreciate such as risk of pressure sores and the interplay of child birth and autonomic dysreflexia.

However in men who are spinal cord injured the impact of the injury on fertility is less clear cut.  16% of men with an SCI are able to achieve ejaculation through sexual stimulation alone and 52% require vibratory stimulation to achieve ejaculation (Soler, et al. 2016).

Though most men with an SCI are able to achieve ejaculation (albeit with stimulation) infertility still presents a problem to most men with an SCI.  Oftentimes, the sperm has a “normal” concentration but very low sperm motility (Brackett, NL. 2012), meaning the sperm doesn’t move particularly efficiently.  Quite soon after injury the sperm is affected and it’s established that approximately 2 weeks after a spinal cord injury semen quality drastically deteriorates.

The scientific literature doesn’t support a single reason as to why sperm motility is affected in those with a spinal cord injury and why it’s affected so soon after injury.  Some research has attributed it to changes in the constituents of the semen plasma, bladder management and ejaculatory impairment.  It appears that recent research has shown that sperm function requires normal secretions from the prostate and dysfunction in this is a potential cause for the reduced fertility in males with a SCI.

There are various treatments for improving sperm motility but none are definitive.  Vitamin C is known to improve semen quality and zinc therapy is also used (however studies of the benefit of zinc therapy on semen quality in the SCI population are yet to be reported).  Bladder management also has an impact on semen quality, research has shown that intermittent catheterisation helps improve semen quality over indwelling catheterisation.

Despite sperm motility often being low in males with an SCI, reassuringly, it is usually still of sufficient quality to achieve good results with intrauterine insemination or IVF (Ibrahim, et al. 2015).  Although both these options can present their own issues; cost. 

General Comments

A spinal cord injury is life changing.  One important consideration for anyone is the impact of the injury on their future family planning.  If you have a personal injury or clinical negligence claim it may be appropriate to discuss with your solicitor what your family plans were prior to the injury and how they have been impacted as a consequence.

Though this may not always be an obvious consideration or even an easy conversation to have when discussing the impact of your injury with your solicitor it’s important to have a dialogue with them as if alternatives are being considered – surrogacy, IVF, etc. – it may be that the costs can be recovered as part of your legal claim. 

Advice?

If you would like advice on how spinal cord injury impacts on fertility then the Spinal Injury Association have plenty of resources on their website.