Sperm and testicular function

A spinal cord injury (SCI) can affect reproductive health, including sperm quality and testicular function. Sexual and reproductive health are important aspects of wellbeing after SCI. Health professionals can play a vital role in assisting people to understand their options and access appropriate support.

Common reproductive changes

• Reduced sperm quality, often due to lower sperm motility (movement).
• Difficulty with ejaculation, which may include:
  • Impaired ejaculation potential or direction
  • Inability to ejaculate (anejaculation)
  • Retrograde ejaculation (semen flows backward into the bladder)
  • Absent or incomplete ejaculation.

Sperm quality

Sperm quality can be affected by several SCI-related factors, including:

• Frequent urinary tract infections (UTIs), prostate or testicular infections
• Higher scrotal temperature, often related to prolonged sitting
• Infrequent ejaculation, leading to stasis of sperm
• Bladder management methods, such as the use of indwelling catheters, reflex voiding or straining. These may negatively affect sperm quality.

Improving sperm quality may involve:

• Preventing UTIs through good bladder care
• Reducing testicular temperature (e.g., wearing loose-fitting, breathable clothing, or using a wheelchair cushion comprised of air for better airflow)
• Increasing ejaculation frequency (e.g. using penile vibrostimulation, see below)
• Considering alternative methods of bladder management. 

Sperm retrieval methods

If ejaculation is difficult or not possible, there are two main options to retrieve sperm. These are penile vibrostimulation and surgical sperm retrieval. Both methods can be utilised to facilitate semen analysis, to establish if there are fertility issues present.

Penile vibrostimulation

This involves applying a vibrator to the glans penis (usually the frenulum) to trigger ejaculation. Important considerations:

• A device with a vibration frequency of 70–100Hz is required.
• Lack of sensation can increase the risk of skin damage or pressure injuries. Care must be taken.
• This method can be managed at home but should first be trialled under the guidance of an experienced clinician, especially in people with injuries at T6 or above, due to the risk of autonomic dysreflexia.
• Some funding bodies may cover device costs; encourage individuals to check with the relevant scheme.

Example of high amplitude penile vibrostimulation device
Source: Men’s Health Downunder

Surgical sperm retrieval

This is performed by a fertility specialist. It involves extracting sperm directly from the testicles and is usually followed by assisted fertility procedures for sperm insemination.

When choosing a specialist, consider whether they have:

• Equipment for accessible procedures (e.g. hoist for transfers).
• Experience managing SCI-specific complications like spasticity or autonomic dysreflexia.

Some funding agencies may cover the cost of this option; encourage individuals to check with the relevant scheme. 

Insemination methods

Depending on sperm quality and ejaculation ability, several methods may assist with conception:

Natural insemination  

If the man is able to ejaculate and sperm quality is good, natural intercourse may result in pregnancy. If conception hasn’t occurred after some time, other options may be considered. 

Artificial insemination  

This involves placing sperm into the vagina or uterus. A fertility specialist can select the healthiest sperm to increase the chance of success.

In-vitro fertilisation techniques 

In-vitro fertilisation (IVF) involves fertilising an egg outside the body with collected sperm. With the assistance of a fertility specialist, there are several IVF techniques available. Only a few healthy sperm are needed for some IVF methods.

Donor insemination  

If the sperm quality is inadequate for use with any of the above techniques, donor sperm may be considered.