Expert Answers Factual Answers to Your Sexual Health Questions
Is there a test to find out if my paraplegic fiance is still fertile?
First, I would encourage him to ask his regular doctor for a referral to a fertility specialist familiar with SCI who can test your fiancé’s semen. If your fiancé is unable to ejaculate through manual stimulation, there are two widely-used and accepted methods to help do the trick: electrical stimulation and penile vibratory stimulation.
Electrical stimulation, otherwise known as rectal probe ejaculation (EEJ), is usually performed under anesthesia in a hospital setting or clinic. An electric probe is inserted into the rectum to stimulate the nerves that control ejaculation.
Penile vibratory stimulation(PVS) ⎼ applying a vibrator to the penis ⎼ is less invasive than electrical stimulation and can be done at home. It doesn’t require anesthesia, and it often feels good for the man...whether he ejaculates or not. In addition, studies at the Miami Project demonstrate better sperm quality in samples obtained by vibratory stimulation. Although many clinics still use only electrical stimulation because it’s more dependable, the American Urological Association recommends vibratory stimulation as the first line of treatment for people with SCI.
Then, the sample is evaluated for the quality of sperm...including sperm count, motility, morphology, viscosity, volume and ability to penetrate mucus. Or, in plain English:
- An average sperm count is about 100 million per milliliter.
- Motility represents the percentage of sperm that are moving...when at least 50% of the sperm are “swimmers” the sample is considered normal.
- Morphology refers to the shape of the sperm. Typically only 50-80% percent are normal, but malformations do not necessarily cause malformations in the fetus.
- Viscosity is the thickness or resistance of the sperm.
- Volume, as opposed to sperm count, measures the total amount of ejaculate and may vary from 1-5 milliliters, or about a teaspoon.
Men with SCI generally have adequate volume and sperm count, but many have an issue with sperm motility. Depending on the results of your fiance’s semen analysis, you have the option of trying home insemination techniques. But even if his sperm’s motility is too low for home insemination, it can still be used in combination with other assisted reproductive technology (ART) to improve the chances of conception. ARTs are ways to deliver sperm to the ovum and a fertility specialist can help you and your fiance determine the best therapy for you.
Thanks for your thoughtful question. I wish you both the best of luck in your marriage, and in your shared desire to have children.
Dr. Tepper directs sexual health education at SexualHealth.com. An AASECT-certified sexuality educator and counselor, his areas of expertise include sexual dysfunctions, sexuality following disability or illness, pleasure and orgasm, relationships, and military and veteran couples' counseling. Dr. Tepper was educated at the University of Pennsylvania and Yale University.