Revised 2023
Why can men with a spinal cord injury (SCI) have infertility?
There are several reasons a man with SCI might have infertility. He may not be able to keep an erection long enough to have intercourse or to ejaculate (release semen) during orgasm. Abnormal retrograde (backwards) ejaculation can also happen, sending the sperm into the bladder. Men with SCI can also have inflammation or infection that can interfere with sperm health and function. Some men with SCI make less sperm because of abnormal nerve signals going to the testicles.
What treatments are available for infertile men with SCI?
Unfortunately, not all causes of infertility in men with SCI are treatable. However, when men with SCI can’t ejaculate, there are several ways sperm can be collected for creating a pregnancy.
How can sperm be obtained from men with SCI?
Sperm can be collected in one of two ways.
Vibratory stimulation:
This is like a vibrator for men. It works best in men with spinal cord injury around the mid-back and does not usually work if the injury is lower in the spine. A small machine that vibrates is placed on the penis to cause release of semen. The semen can be used with intrauterine insemination (IUI or sperm can be put into the uterus with a syringe) or in vitro fertilization (IVF or test tube baby), depending on how much is made and the quality of it. Sometimes, the semen can be put directly into the woman’s vagina to allow natural conception.
Testicular biopsy:
Testicular biopsy is a procedure where some tissue is removed from the testicle. This procedure can be done using a needle inserted into the testicle or by surgically opening the testicle to remove a small piece (biopsy). Sperm obtained this way can only be used in IVF (or test tube baby) and then each sperm directly injected into an egg to create an embryo (ICSI)
Once sperm is collected, how is it used to create a pregnancy?
During IVF, a woman’s eggs are collected and placed together with the sperm in a laboratory to fertilize. The fertilized eggs are then returned to the woman’s uterus. In some cases, sperm is injected directly into each egg (ICSI) to achieve fertilization. Pregnancy is more likely after IVF (with or without ICSI) than with IUI, but IVF is more invasive and costs more.
For more information, see the ASRM booklet titled “Assisted reproductive technologies” and the factsheet titled “Intracytoplasmic sperm injection.”
How do I know which method is right for us?
You should discuss your spinal cord injury and fertility goals with your doctor to find out which method is most appropriate for you.
Male Fertility/Andrology
AUA Releases Male Infertility Guideline Amendment
The AUA, in collaboration with the American Society for Reproductive Medicine (ASRM), has released the 2024 amendment to the Male Infertility Guideline.
View the Press Release
SART Fertility Experts - Wellness and Fertility: Diet, Sleep and Exercise
Drs. Timothy Hickman and Rashmi Kudesia discuss the links between lifestyle and fertility. Listen to the Episode
Male Fertility Journey
About 20% of infertility cases are due to a male factor alone. Another 30% involves both male and female factors.
View the Patient Journey
SART Fertility Experts - Urology and Male Reproductive Health
Stress and infertility
It is not clear how exactly stress impacts fertility. Read the Fact Sheet
Optimizing Natural Fertility
Before attempting pregnancy, a woman should make sure she is healthy enough for pregnancy by adopting a healthier lifestyle and taking prenatal vitamins. If she has a medical or genetic condition or risk of one, she should seek advice from a medical professional before conceiving (becoming pregnant) View the fact sheet
Optimizing Male Fertility
About 20% of infertility cases are due to a male factor alone. Another 30% involves both male and female factors. View the fact sheet
Cancer and its impact on sperm, cryopreservation, and fertility
This can be confusing since the terms are often used interchangeably in the media and casual conversation. View the fact sheet
Male Fertility Evaluation: What do I need to know?
Infertility is the inability to achieve pregnancy after one year of unprotected sex. View the fact sheet
Sperm morphology (shape): Does it affect fertility?
The most common test of a man’s fertility is a semen analysis. View the fact sheet
Fertility Options for Men with Spinal Cord Injury
There are several reasons a man with a spinal cord injury (SCI) might have infertility. View the fact sheet
Varicocele
A varicocele is a variation of normal anatomy in which veins in the scrotum (the sac that holds the testicles) become enlarged and sometimes even visible. View the fact sheet
Weight and fertility
One of the easiest ways to determine if you are underweight or overweight is to calculate your body mass index (BMI). View the fact sheet
SART Fertility Experts - Male Factor
Intracytoplasmic sperm injection (ICSI)
A procedure called intracytoplasmic sperm injection (ICSI) can be done along with in vitro fertilization (IVF) if a sperm cannot penetrate the outer layer of an egg. Read the Fact Sheet
SART Fertility Experts - IVF: Cycles of Hope and Heartbreak
Does stress cause infertility or is it the other way round? Listen to the Episode
Fertility Options After Vasectomy
Vasectomy is currently one of the most common methods of sterilization in the United States. After your vasectomy, if you change your mind about having children, there are two procedures that can help you have a child with your partner. View the Fact Sheet
Testosterone use and male infertility
Testosterone (also referred to as “T”) is a hormone produced in men by the testes (testicles). View the fact sheet
SART Fertility Experts - Male Fertility
Did you know that up to 40% of infertile couples suffer from male factor infertility? Listen to the Episode
Infertility: an Overview (booklet)
Infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. View the booklet
Male Fertility and Infertility - a patient education video
Male Factor Infertility is responsible for about 30% of infertility cases and can contribute infertility to an additional 20% of cases. Watch Video
Infertility
Infertility is the result of a disease (an interruption, cessation, or disorder of body functions, systems, or organs) of the male or female reproductive tract which prevents the conception of a child or the ability to carry a pregnancy to delivery. Watch Video
Basic Infertility Evaluation
Dr. Roger Lobo of the American Society for Reproductive Medicine discusses the various methods to evaluate infertility. Watch Video
Infertility Treatments
Dr. Roger Lobo of the American Society for Reproductive Medicine discusses the various treatments for infertility. Watch Video
Understanding Fertility
In this video series, Dr. Roger Lobo explains the basics of infertility, including causes, treatments and coping methods. Watch Video
Surviving the Roller Coaster Emotions of Infertility Treatment
The experience of infertility is a rollercoaster of hope and disappointment. Treatment presents an opportunity for hope as well as a new set of challenges. Watch Video
Causes of Male Infertility
Dr. Roger Lobo, of the American Society for Reproductive Medicine explains the causes of male infertility. Watch Video
FAQ About Infertility
Infertility is not an inconvenience; it's a disease of the reproductive system that impairs the body's ability to perform the basic function of reproduction. Learn the facts
Male Fertility Infographics
ASRM has prepared infographics to illustrate the subject of Male Fertility better. View the infographicsSperm
Sperm DNA integrity testing: what is it?
Genetic material is carried in our DNA, also known as deoxyribonucleic acid. View the fact sheet
Sperm morphology (shape): Does it affect fertility?
The most common test of a man’s fertility is a semen analysis. View the fact sheet
SART Fertility Experts - Behind the Scenes in the IVF Lab
Dr. Sangita Jindal, helps patients understand the importance of the IVF lab when choosing an IVF program. Listen to the Episode
Intracytoplasmic sperm injection (ICSI)
A procedure called intracytoplasmic sperm injection (ICSI) can be done along with in vitro fertilization (IVF) if a sperm cannot penetrate the outer layer of an egg. Read the Fact Sheet
Gamete and Embryo Donation: Deciding Whether To Tell
Gamete donation is giving sperm, eggs, both, or embryos to another person/couple so that another person/couple may have a child. View this Fact Sheet
Semen Analysis Infographics
ASRM has prepared infographics to illustrate the subject of Semen Analysis better. View the Infographics
Smoking Infographics
ASRM has prepared infographics to illustrate the subject of Smoking and Fertility better. View the InfographicsFact Sheets/Booklets
View more fact sheets and booklets written by the ASRM Patient Education Committee.
Menopausal Transition (Perimenopause): What Is It?
The menopausal transition (perimenopause) is the period that links a woman’s reproductive (childbearing) years and menopause.
Osteoporosis
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Hyperprolactinemia (High Prolactin Levels)
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