03/25/2013 // Concord, CA, USA // LifeCare123 // Greg A. Vigna M.D., J.D. // (press release)

Medical Perspective:

‘Eighty percent of new spinal cord injuries are in males, with most of those occurring during the reproductive years, and a third of those in married men’. Early during the acute stage of the spinal cord injury, the patient, spouse, and family members will ask, “Is fathering a child possible?” The answers to this is a resounding yes, and men with spinal cord injuries who desire to biologically sire a child should be encouraged to seek medical attention at a center that specializes in fertility problems in spinal cord injuries to deal with the issues related to erectile and ejaculatory dysfunction, and inadequate sperm quality that occur in spinal cord patients reports Greg A. Vigna M.D., J.D. of Life Care Solutions Group.

Erectile dysfunction alone will not impair fertility in a spinal cord patient but should be treated to ‘improve the psychosexual health and self-image of a patient, and natural conception can occur in up to 10% of couples who include a male spinal cord patient’. Oral medications (Viagra), injections into the penis, medications inserted into the penis, and vacuum pumps have been determined to be effective in erectile dysfunction in spinal cord patients. It is my opinion, after treating thousands of spine injured patients, that oral medications such has Viagra is effective and safe if used appropriately and problems with low blood pressure are uncommon or at least not reported on follow up. Vacuum pumps are effective but must be used with caution to prevent skin injury. ‘Spinal cord men most commonly will have poor or no ejaculation as a cause for impaired fertility and will need some medical assistance to obtain sperm’. Penile vibratory stimulation and electro-ejaculation are methods to obtain sperm by way of assisted ejaculation. These are preferred methods to surgically retrieving sperm from the testicles because it is noninvasive and higher numbers of sperm are obtained via ejaculation. ‘Vibratory stimulation should be tried first is 88% successful in patients with injuries above T10’. Autonomic dysreflexia can occur in patients with injuries above T6 and this can be decreased by premedication with antihypertensives. ‘If vibratory stimulation fails, electro-ejaculation has been exceptionally successful with a 95% success rate’ with again the complication of autonomic dysreflexia.

For patients who cannot achieve ejaculation surgical procedures are available to retrieve sperm. I believe these procedures should be tried only after penile and electro-ejaculation has failed. ‘Several reasons for this is the invasive nature, cost, risk of hematoma, risk of testicular atrophy, and decrease in numbers of mobile sperm obtained’. This decrease in motile sperm by way of surgical procedures may make in vitro fertilization impossible and require a technique which involves injecting the sperm directly into the ovum (egg) called intracytoplasmic sperm injection (ICIS), which is very costly. Sperm obtained by vibratory stimulation or electro-ejaculation can be used for both direct injection into the woman’s uterus or vagina to achieve pregnancy or can be used in vitro fertilization.

Following a spinal cord injury, there is overall a decrease in sperm quality which also contributes to infertility. Researches are not exactly sure why this occurs but it is known that ‘for a limited period in the acute phase, usually for about 6-12 days after injury, normal semen can be obtained by electro-ejaculation from some cord-injured men’. It is also believed that sperm quality may improve with regular ejaculation over time. Patients with poor sperm quality may require in vitro fertilization or intracytoplasmic sperm injection to achieve pregnancy. It is my opinion that there are cases where san acute spinal cord male patient could be offered vibratory or electro-ejaculation to achieve normal semen and then the semen can be frozen for future use. This option, however, is largely not considered in today’s medical/surgical hospitals.

Life Care Perspective:

All necessary and appropriate future medical costs and costs related to the psychosocial welfare of the spinal cord patient should be included in the life care plan. Psychosocial costs would include sexual counseling, marital counseling, and individual counseling. All medications and devices related to the erectile dysfunction must be included. All medications, physician visits, medical procedures, and other fertility related costs must be included. Future costs regarding aid and attendant needs of the future children may need to be provided for a paralyzed patient.

Lawyer Perspective:

A spinal cord injury causing fertility issues can drive a high damages award. Because these conditions may last forever, assuming liability can be proven, the loss of fertility and costs related to the erectile dysfunction can be calculated over the projected life span of a client. Jurors are generally sympathetic when a client loses something significant in their lives, and due to the different invasive procedures a client must undergo, the future economic damages and noneconomic (pain and suffering) can be significant. A jury should thoroughly understand the different ramifications, complications and what the future will bring to a client suffering these problems. A lawyer must understand the client’s future plans related to becoming a biologic father and then present testimony of the client, experts, and a life care planner regarding the past and future costs, as well as the past and future pain and suffering. The lawyer must also consider future aid and attendant cost for raising the child by the spinal cord injured client.

Media Contact:

Greg A. Vigna M.D., J.D

Serious Injury Lawyer

888.990.9410

Media Information:

Address: 1401 Willow Pass Road, Concord, CA 94520
Phone: 888.990.9410
Url: Lifecare Solutions Group