Thinking about starting a family?

Former consultant obstetrician and gynaecologist, Felicity Ashworth, developed a specialist interest in supporting women with SCI during her 27-year career at Stoke Mandeville Hospital and the National Spinal Injuries Centre. Here she shares her expertise on fertility and talks through the first steps to planning a family from the woman’s perspective post-SCI.

 

SCI and fertility from the female perspective

The first thing to say is that having an SCI doesn’t preclude you from getting pregnant naturally. Far from it in fact. Most of the factors that affect female fertility will be completely unconnected with your SCI. There are some aspects, such as age or Body Mass Index (BMI), that might be loosely related. But generally speaking, an SCI should be no barrier to conceiving naturally.

Factors in female fertility

Two key factors for any woman wishing to conceive naturally are maternal age and BMI. The ideal range for a woman’s BMI is between 19 and up to 30 when she’s attempting to conceive. Being overweight or underweight can make conception less likely. These crucial factors are by no means limited to women with SCI, but having an SCI can present additional challenges in both areas. Reduced mobility and decreased muscle mass post-injury can make it harder to maintain the ideal BMI. And if you’re focusing on rehabilitation and getting back to your everyday following an SCI, then you will inevitably delay thoughts of motherhood for longer than you might otherwise have done. Not to mention the fact that sustaining an SCI can mean your periods stop for anything from six months to a year as your body settles into its new ‘normal’.

Pre-pregnancy planning

This sounds very boring and unromantic I know! But it’s what I would advise anyone hoping to start a family. Before trying to conceive, I’d advise every woman to:

· Make sure cervical smears are up-to-date

· Stop smoking

· Start taking 0.4mg of folic acid every day

· Check BMI – aim for somewhere between 19 and up to 30

· Check any medication is compatible with pregnancy

Let’s talk about sex

For women with an SCI, this can be the most problematic part of conceiving naturally. I’d recommend talking to your OT or a psychosexual counsellor about the best positions to try. Most spinal centres have a counsellor or therapist trained to advise on this. If there is a reason why the sperm cannot get into the vagina, timed vaginal inseminations can be a successful alternative.

When to get help

Infertility is defined as the inability to conceive despite regular (two to three times a week) intercourse without contraception for 12 months. You can go to see your GP to talk through options at any stage, or speak to your SCI clinic. If you choose to be referred to a fertility clinic, whether for assessment or treatment, do make sure the clinic is set up with all the equipment and knowledge to support you safely. Access, beds, hoists and staff awareness will be crucial. And you will be the expert patient in this scenario as you find yourself in so many medical situations I’m sure! Don’t be afraid to be assertive, but do consider having someone vocal to accompany you at each stage, because it can be quite an emotional journey.

What happens next?

The first thing your GP will want to check before they refer you is whether you are ovulating (i.e. producing eggs). This can be done in various ways but most reliably with a blood test. Ovulatory failure is the most common cause of infertility in women, but it can be treated in many cases with a drug such as clomifene to trigger ovulation. If your partner is male, then he will need a sperm test, which his GP can arrange.

A pelvic ultrasound is important to exclude ovarian cysts or endometriosis, because for women with SCI, pain is no longer a reliable indicator of such conditions. Once problems with ovulation are eliminated as a possible cause, then specialists may recommend a test to see whether your fallopian tubes are blocked (a far less common cause of infertility). The possibilities for this are a hysterosalpingogram (XRay), a scan dye test or, less commonly, an operation called a laparoscopy.

Treatment options

In around a third of cases, there’ll be no obvious cause for infertility. It can be frustrating not to identify a cause, but actually it can be a positive sign. And it’s important to have explored all the avenues above because the results could dictate the next step: your treatment.

For more information about fertility and treatments such as IVF, subscribe to Forward to read Felicity’s article in full.

You can also find out more here: https://www.rcog.org.uk/en/patients/