Fertility and spina bifida
Female fertility
Female fertility is not generally affected by spina bifida but there are some important considerations for pregnancy.
Planning
See our information on Pregnancy for Women with spina bifida. It might take longer to get ‘pregnancy-ready’ than for women without spina bifida, depending on your health. Avoid pregnancy until you’re sure it’s right and safe for you.
Consider folic acid
Taking folic acid before conception can lower your chances of your baby having spina bifida or anencephaly. We understand that this is a personal choice and that some couples will find it unnecessary or distasteful to do this.
For couples that do wish to try to reduce the chance of neural tube conditions, it is recommended that all sexually active women take a daily supplement of folic acid. If you or your partner have spina bifida your chances of having a baby with spina bifida or anencephaly are increased. To lower this chance, it is recommended that women with spina bifida take a daily 5 mg supplement of folic acid for at least 8 weeks prior to conception, and until the 12th week of pregnancy. This is only available on prescription.
Many pregnancies are unplanned and accidental pregnancies do occur, so if you have started having sex talk to your GP about reliable contraceptives and folic acid.
Male Fertility
Male fertility can be affected by spina bifida. The erectile problems described earlier can impact on fertility and men with spina bifida may also have issues with ejaculation as this is controlled by the spinal cord:
- Delayed ejaculation is where there is a repeated and unwanted delay in (or absence of) ejaculation. This may be diagnosed if you frequently have delays in ejaculation of at least 30 minutes and/or are unable to ejaculate on more than half of all sexual occasions. A range of medical options may be available so consult your GP for advice. There are medications that can help reduce ejaculatory delay and if you want to have children there are various possible sperm retrieval procedures. Harvested sperm can then be used in artificial insemination (AI) or in vitro fertilisation (IVF).
- Retrograde ejaculation is where semen goes backwards into the bladder instead of passing along the urethra and out of the tip of the penis. During ejaculation the neck of the bladder should close to help send the semen the right way along the urethra. In men with spina bifida the nerves that control bladder closure can be damaged causing semen to take the easiest route and travel backwards into the bladder. The major signs of retrograde ejaculation are producing little/no semen during orgasm and having cloudy urine after sex (due to it containing semen). Retrograde ejaculation doesn’t usually require treatment unless trying for a baby because it doesn’t cause extra health or sexual problems: the men can achieve orgasm just not release ejaculate. Men with retrograde ejaculation wanting to have children may be able to do so by AI or IVF with sperm taken from their urine or surgically extracted from their testes.
Having said this, many men with spina bifida become fathers naturally, with no intervention. If you are trying for a baby, and nothing happens after one year, ask for tests and a referral to an Assisted Conception Unit if that would help. If you’re not actively trying for a baby, don’t presume you will have fertility problems, use reliable contraception until you’re ready for a baby.