Can Men Have Children After a Spinal Cord Injury? Fertility Options Explained
Yes. Many men can have biological children after a spinal cord injury.
A spinal cord injury can make natural conception more difficult, particularly when it affects ejaculation or sperm movement. However, it usually does not remove the possibility of biological fatherhood. Treatments can help obtain sperm, and fertility procedures ranging from insemination to IVF may then be used to achieve pregnancy.[1–4]
The best approach depends on your level and completeness of injury, whether you can ejaculate, the quality of the sperm obtained and your partner’s fertility.
How does a spinal cord injury affect male fertility?
Male fertility after spinal cord injury is commonly affected in three main ways.
Difficulty obtaining an erection
Some men have difficulty achieving or maintaining an erection after spinal cord injury. Erectile dysfunction can make intercourse more difficult, but it does not necessarily mean that sperm production has stopped.
Treatments such as tablets, penile injections, vacuum erection devices and penile implants can help selected men achieve an erection. However, treating the erection does not always restore ejaculation.
Difficulty ejaculating
Most men with significant spinal cord injuries cannot ejaculate normally during intercourse or masturbation. The nerves involved in ejaculation are different from those responsible for erection, so a man may be able to achieve an erection but remain unable to release semen.[3,4]
Some men experience:
Anejaculation: no semen comes out.
Retrograde ejaculation: semen passes backwards into the bladder.
Weak or incomplete ejaculation: only a small amount of semen is released.
European Association of Urology guidance recommends penile vibratory stimulation as the first treatment for men with spinal cord injury who cannot ejaculate. Electroejaculation and surgical sperm retrieval may be considered when vibratory stimulation is unsuccessful.[1]
Reduced sperm movement
Men with spinal cord injury often continue to produce sperm. Sperm concentration may be normal or even relatively high, but the sperm frequently have reduced movement and viability.[3,4]
This means that the main problem is often not an absence of sperm. Instead, it is difficulty releasing the sperm and a lower chance that the sperm will travel to and fertilise an egg naturally.
In a 2020 case-control study, men with spinal cord injury had much lower progressive sperm motility than men with other causes of infertility. Despite this, assisted reproductive treatment produced pregnancy and live-birth rates per cycle that were not statistically different between the groups.[7]
Can pregnancy occur naturally?
Natural pregnancy may be possible when a man can:
achieve an erection suitable for intercourse
ejaculate semen forwards through the penis
produce enough moving sperm
A semen analysis can help estimate whether natural conception is realistic. However, a single semen analysis cannot guarantee or rule out pregnancy. Results can vary between samples, and the fertility of both partners must be considered.
Current male-infertility guidelines recommend assessing both partners at the same time rather than completing one partner’s assessment before starting the other.[2]
What tests may be needed?
A fertility assessment for a man with spinal cord injury may include:
a detailed history of the spinal injury, sexual function and ejaculation
examination of the penis and testicles
semen analysis when a sample can be produced
examination of urine after orgasm if retrograde ejaculation is suspected
blood tests such as testosterone, follicle-stimulating hormone and luteinising hormone
review of medications and bladder management
assessment of the female partner’s fertility
Men should also tell their doctor about previous autonomic dysreflexia, urinary infections, genital surgery, testicular problems and any fertility treatment already attempted.
A warning about testosterone treatment
Testosterone replacement can substantially reduce or completely suppress sperm production. Men who are considering future biological children should not start testosterone without discussing fertility preservation and alternatives with a reproductive urologist.[2]
This includes testosterone injections, gels, creams and some non-prescribed anabolic steroids.
How can sperm be obtained after spinal cord injury?
Treatment generally follows a stepwise approach, beginning with the least invasive option.
1. Penile vibratory stimulation
Penile vibratory stimulation, often shortened to PVS, applies controlled high-frequency vibration to the head of the penis. This stimulates the spinal ejaculation reflex and may produce an ejaculate even when the man has little or no genital sensation.
PVS is recommended as the first-line method for sperm retrieval in men with spinal cord injury who cannot ejaculate.[1,3,11] It tends to work best when the injury is above approximately T9 or T10 and the relevant reflex pathways remain intact.[5,9]
Studies have shown that specialised PVS protocols can successfully produce ejaculation in many appropriately selected men. A small 2021 device study achieved ejaculation in 13 of 15 participants, although results from a small specialist cohort should not be assumed to apply to every patient.[8]
A medical PVS device differs from an ordinary household vibrator. The frequency, amplitude, positioning and duration of stimulation can affect the likelihood of success.[5,11]
2. Electroejaculation
If PVS does not work, electroejaculation may be considered. During this procedure, a specialised probe is placed in the rectum and delivers controlled stimulation to the nerves involved in ejaculation.
Electroejaculation can often obtain semen when PVS has failed. It is normally performed in a specialist setting, and anaesthesia or sedation may be required in men who retain pelvic sensation.[1,6]
Semen obtained through electroejaculation can be assessed immediately to decide whether it is suitable for insemination, IVF or intracytoplasmic sperm injection.[6]
3. Surgical sperm retrieval
When ejaculation cannot be produced, sperm may be collected directly from the epididymis or testicle.
Because surgically retrieved sperm are usually available in limited numbers, they are most often used with IVF and intracytoplasmic sperm injection, known as ICSI. During ICSI, an embryologist injects a single sperm directly into an egg.
A 2026 retrospective study reported successful epididymal sperm retrieval in approximately 61% of 69 men with complete lower-body spinal cord injury. This is an emerging approach from a single fertility centre and is not yet a replacement for established stepwise management with PVS and electroejaculation.[12]
Which fertility treatment will be needed?
The choice depends on the number and quality of moving sperm obtained, as well as the female partner’s age, ovarian reserve and reproductive health.
Timed intercourse or intravaginal insemination
When ejaculation can be achieved and the sample contains a good number of moving sperm, the couple may try timed intercourse.
In selected cases, a fertility team may discuss placing collected semen into the vagina around ovulation. Medical advice is important before attempting home insemination, particularly when ejaculation procedures create a risk of autonomic dysreflexia.
Intrauterine insemination
During intrauterine insemination, or IUI, the laboratory prepares the semen and places the moving sperm directly inside the uterus around ovulation.
IUI may be suitable when the processed sample contains enough moving sperm and there are no major female fertility factors.
IVF and ICSI
IVF may be recommended when:
sperm movement is very low;
only a small number of sperm can be obtained;
sperm have been retrieved surgically;
IUI has been unsuccessful;
the female partner has a fertility problem;
time is important because of the female partner’s age.
ICSI is commonly used for severe male-factor infertility because only one suitable sperm is required for each mature egg.
Research involving couples undergoing IVF or ICSI has shown that sperm obtained from men with spinal cord injury can result in pregnancies and live births.[7]
Is sperm retrieval safe after spinal cord injury?
Men with injuries at or above T6 may be at risk of autonomic dysreflexia during sexual stimulation, PVS, electroejaculation or other procedures below the level of injury.
Autonomic dysreflexia can cause a sudden and potentially dangerous rise in blood pressure. Symptoms may include:
a severe or pounding headache;
sweating or flushing above the injury;
blurred vision;
nasal congestion;
goosebumps;
anxiety or chest discomfort.
Some episodes cause few obvious symptoms despite a substantial rise in blood pressure. For this reason, men at risk should undergo initial fertility procedures in an appropriate medical setting with blood-pressure monitoring and an individual prevention and treatment plan.[8,10,11]
Autonomic dysreflexia is a medical emergency and is most commonly associated with cervical or high thoracic injuries.[10]
Should sperm be frozen?
When a useful sample is successfully obtained, freezing sperm may reduce the need to repeat the retrieval procedure. Whether sperm banking is worthwhile depends on:
the number and movement of sperm;
the retrieval method;
whether IUI or IVF is planned;
the expected number of treatment cycles;
the likelihood of obtaining another sample.
When should you see a fertility specialist?
Consider seeking advice early when:
you cannot ejaculate after spinal cord injury;
very little semen is released;
you have been trying to conceive without success;
your partner is aged over 35;
you are considering testosterone treatment;
you want to freeze sperm for the future;
previous PVS or fertility treatment has failed;
you experience autonomic dysreflexia during sexual activity.
Early assessment can prevent unnecessary delays and allow the male and female fertility evaluations to occur together.
Take home message
A spinal cord injury can make conception more complicated, but it does not usually remove the possibility of biological fatherhood.
Many men continue to produce sperm. When ejaculation is difficult, sperm can often be obtained using penile vibratory stimulation, electroejaculation or surgical retrieval. The sample can then be used for timed insemination, IUI, IVF or ICSI, depending on sperm quality and the couple’s circumstances.
A coordinated assessment involving a reproductive urologist, spinal-injury team and fertility specialist provides the best opportunity to select a safe and effective pathway.
Book a confidential fertility consultation
Dr Jack Crozier is a Brisbane urologist and andrology surgeon with a subspecialty interest in male infertility, ejaculatory dysfunction and reproductive care after spinal cord injury.
A confidential consultation provides an opportunity to review your injury, ejaculation, medications and previous fertility testing, and to develop an individual plan for semen analysis, assisted ejaculation or sperm retrieval.
This article provides general educational information and is not a substitute for individual medical advice. Fertility procedures in men at risk of autonomic dysreflexia should only be undertaken with appropriate specialist assessment and safety precautions.
References
European Association of Urology. EAU guidelines on sexual and reproductive health: disorders of ejaculation. Arnhem: EAU Guidelines Office; 2026.
Brannigan RE, Hermanson L, Kaczmarek J, Kim SK, Kirkby E, Tanrikut C. Updates to male infertility: AUA/ASRM guideline (2024). J Urol. 2024;212(6):789-799.
Sinha V, Elliott S, Ibrahim E, Lynne CM, Brackett NL. Reproductive health of men with spinal cord injury. Top Spinal Cord Inj Rehabil. 2017;23(1):31-41.
Anderson R, Moses R, Lenherr S, Hotaling JM, Myers J. Spinal cord injury and male infertility—a review of current literature, knowledge gaps, and future research. Transl Androl Urol. 2018;7(Suppl 3):S373-S382.
Chong W, Ibrahim E, Aballa TC, Lynne CM, Brackett NL. Comparison of three methods of penile vibratory stimulation for semen retrieval in men with spinal cord injury. Spinal Cord. 2017;55(10):921-925.
Soeterik TFW, Veenboer PW, Oude-Ophuis RJA, Lock TMTW. Electroejaculation in patients with spinal cord injuries: a 21-year, single-center experience. Int J Urol. 2017;24(2):157-161.
Cito G, Picone R, Fucci R, et al. Reproductive outcomes in infertile men with spinal cord injury: a retrospective case-control analysis. Urology. 2020;141:82-88.
Ibrahim E, Jensen CFS, Sunara I, et al. Evaluation of a re-engineered device for penile vibratory stimulation in men with spinal cord injury. Spinal Cord. 2021;59(2):151-158.
Alisseril S, Prakash NB, Chandy BR, Tharion G. Clinical predictors of vibrator-assisted ejaculation following spinal cord injury: a prospective observational study. J Neurosci Rural Pract. 2021;12(4):758-763.
Krassioukov A, Linsenmeyer TA, Beck LA, et al. Evaluation and management of autonomic dysreflexia and other autonomic dysfunctions: preventing the highs and lows. J Spinal Cord Med. 2021;44(4):631-683.
Ibrahim E, Brackett NL, Lynne CM. Penile vibratory stimulation for semen retrieval in men with spinal cord injury: patient perspectives. Res Rep Urol. 2022;14:149-157.
Makino Y, Tanaka A, Takemoto Y, Nagayoshi M, Fujimoto S, Tanaka I. Cauda epididymal sperm aspiration as a novel approach for spinal cord injury associated male infertility. Spinal Cord. 2026;64(6):571-576.
