Life on Wheels (73 page)

The potency problem can be solved by collecting and then freezing ejaculate, preparing it for artificial insemination at a later time. Not all frozen sperm recover the ability to swim, so this process involves gaining several samples and then combining them with a fresh ejaculate before inseminating the woman. In another study led by Osvaldo Padron at the University of Miami in 1994, freezing sperm of spinal cord–injured men was no more destructive than for ablebodied men.
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In some cases, taking hormones can help produce more sperm to aid this process. There may be supplements you can take to improve quality of sperm.

There are a number of methods for becoming pregnant—that is, when the traditional approach isn’t working. They range in cost and complexity. Typically, you would start with the least expensive and least invasive methods.

Some couples are willing to invest almost any amount of time, expense, physical stress, and emotion to have a child of their own. It can be a considerable drain. A single advanced procedure can cost as much as $15,000 per try, whereas using vibration and at-home insemination is very inexpensive. Most who succeed say that, having had their child, it was well worth whatever they went through. Yet the success rate is not high, so there is the risk of being left exhausted and depressed—and broke! You and your partner need to fully explore your feelings about having your own biologic child and weigh what you discover against current medical options to decide what is best for you.

When the man is able to produce an ejaculate—by any of the methods mentioned earlier—sperm are collected and then the woman is inseminated by injecting the ejaculate with a needleless syringe. When a procedure such as electroejaculation is performed in an office or clinic, the insemination will also be performed there. A couple can also increase the odds of success by the use of drugs that stimulate the production of more than one egg per cycle and by using standard methods to identify the woman’s peak ovulation.

When normal ejaculation occurs, the sperm is sent into the cervix at approximately 30 miles per hour. With the injection method, sperm have to be helped along with gravity by having the woman lie on her back and elevate her pelvis for a period of time after injection.

Modern science offers several options for uniting a sperm and an egg. A couple can consider:

Intrauterine insemination. Sperm are collected and analyzed for quality and quantity. The specimen is washed and concentrated in preparation for insemination. The woman is monitored for her cycles, and, just before ovulation, a hormone is given to induce it. On the day of insemination, a fresh ejaculate is obtained, the concentrated specimen is added to it, and then it is injected directly into the uterus.

Intratubal insemination. This method is recommended when there are two eggs in the same fallopian tube, which is where insemination normally takes place. With intratubal insemination, the ejaculate is delivered via a catheter while the physician watches with ultrasound, and the sperm are placed as close to the ovum as possible to increase the chance of success.

In vitro fertilization-embryo transfer. Widely known as the test-tube baby procedure, the goal here is to generate as many healthy eggs as possible in order to harvest them before ovulation and perform the insemination outside of the body. In 24 hours, it is possible to observe if fertilization has taken place and then replace the embryos into the uterus. This procedure has shown only a 12% to 17% success rate. Gamete intrafallopian transfer. Eggs are harvested as in IVF, but, rather than being combined outside in a dish, the eggs and sperm are placed back into the fallopian tubes via a catheter. The process proceeds naturally within the woman’s body with a 36% success rate.

Zygote intrafallopian transfer. Insemination is performed in a dish to produce viable embryos, and then the embryos are placed into the fallopian tubes rather than the uterus. This procedure has a 37% success rate.

Intracytoplasmic sperm injection. It is now possible to extract sperm from an ejaculate or directly from either the testicles or the epididymis—a very long, convoluted tube in which sperm mature and are stored until ejaculation. These sperm are then injected into an egg using the vitro fertilization, gamete intrafallopian transfer, or zygote intrafallopian transfer process. Only a few motile sperm are required for the process.

Pregnancy involves major changes to the body and metabolism. Some of the possible effects for any woman include anemia, thrombophlebitis, swelling in the legs, blood pressure changes, carpal tunnel syndrome, infections, constipation, morning sickness, and so on. Any of these effects is minimized by being in good health at the beginning of the pregnancy and making a commitment to the best prenatal and postnatal care.

A pregnant woman using a wheelchair faces additional issues. As you gain weight, there will be increased ischial pressure and added risk of skin breakdown. Be certain to have a proper and well-maintained wheelchair cushion. A different product might be necessary during the later stage of the pregnancy. You will need to do pressure relief pushups or change your posture more often to prevent sores, so some upper-body exercise for added arm strength might be in order. As you gain weight, you might even need a wider wheelchair, especially if you are being pinched in the hips, where there is risk of skin breakdown. Take measures to ensure the health of your skin, keeping it very clean, optimizing your diet for healthy tissue and circulation.

Any medications you take for bladder control, stool softening, control of spasms, or other implications of your disability need to be completely reviewed with your doctor at the earliest possible stage of your pregnancy. Bladder infections during pregnancy present a risk to the fetus. Certain antibiotics used to treat infections can be even more dangerous to the baby. Some women use Valium to control spasms. There are cases of babies who have had to endure Valium withdrawal after birth.

Miscarriage rates are no different for disabled women than for the general population. Spinal cord–injured women are at no increased risk of having children with birth defects. Birth weights are typically within normal ranges. Women with multiple sclerosis or muscular dystrophy may pass on genetic tendencies to these disabilities.

You might not sense the early signs of labor if you have spinal injury above T10 and could miss the opportunity to prepare for delivery before your water breaks. Normal vaginal delivery is possible in most cases, but, if you are without use of abdominal muscles, the doctor might need to assist in lieu of your inability to push down. Forceps, a vacuum extraction unit, or an episiotomy—in which incisions are made to enlarge the vaginal opening—might be necessary. Cesarean delivery—which recent studies have found is performed more than is necessary—may be necessary in some cases, but no more often than for nondisabled women.

Some doctors recommend beginning cervical checks at 26 weeks, since there is some statistical evidence of increased risk of premature delivery by spinal cord–injured women. They might even recommend hospitalization after 32 weeks to monitor the pregnancy as closely as possible. There is risk of dysreflexia during delivery for women injured above T6, a fact of which your obstetrician should be aware.

Disabled women can breastfeed. This is a reflexive response initiated by the baby’s sucking. Some women injured above T6 experience a decrease in milk production after a time due to lack of nipple sensation.

For a woman using a wheelchair, pregnancy has its extra challenges. For this couple, it raised questions about having another child:

Pregnancy is a demanding experience for any woman. When you provide for special needs while working with an obstetrician or midwife who understands those needs, you have the best chance of a manageable pregnancy in which you maintain good health.

Only some couples unable to have a child of their own can afford the new high-tech approaches to producing a birth. Financially and emotionally, the cost gets too high. Couples may also choose not to have invasive hormonal or surgical treatments. Adoption is a possibility, but this is not an easy option either.

Most children available for adoption are from an ethnic-minority background. In the U.S., most parents looking for children to adopt are Caucasian and—like other prospective parents—prefer to find a child of the same race as their own. The competition is pretty stiff, since ablebodied parents tend to be given the advantage by agencies. Another portion of the children have health problems or were abused. It is harder to find homes for these children. They are a challenge for any parents to raise, but all the more so for a disabled parent, depending on the parents’ capacities and resources. But, for someone with a disability who feels a passionate calling to share his or her love as a parent, these issues can be resolved.