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Making Babies: At-Home Vibrostimulation and Insemination by By Mitch Tepper
Editor: In the January issue of New Mobility, Mitch Tepper described the joy his
wife, Cheryl, and he shared in conceiving their son, Jeremy. Since their success was
partly due to vibratory stimulation and at-home insemination, readers have
requested more details.
Whether your goal is to have children or to ejaculate for the sense of completeness
it brings, vibratory stimulation is a relatively safe and effective technique. It works
best for men with complete T10 and higher spinal cord injuries, or incomplete
injuries at any level--assuming a neurologically intact lumbosacral cord in either
case. It may also work for people with other neurological impairments such as
multiple sclerosis and transverse myelitis.
People injured at or above T6, or who have difficulty controlling their blood
pressure, need to take precautions to avoid autonomic dysreflexia--a spike in blood
pressure that can lead to convulsions and/or stroke if not treated immediately. For
those at risk, Dr. Nancy Brackett of the Miami Project recommends 20-40 mg of
nifedipine, by mouth, 45 minutes prior to ejaculation.
Studies indicate that only about 10 percent of men with complete spinal cord lesions
ejaculate during vaginal intercourse. This fact, combined with decreased erectile
function and sperm quality, contributes to the high rate of infertility among men
with SCI.
The first step toward exploring your own fertility is to retrieve some sperm. There
are two widely used and accepted methods: electrical and vibratory stimulation.
Electrical stimulation, otherwise known as electroejaculation stimulation (EES), is
usually performed under anesthesia in a hospital setting or clinic. An electric probe
is inserted into the rectum to stimulate the nerves responsible for controlling
emission and ejaculation.
Vibratory stimulation--applying a vibrator to the penis--is less invasive than
electrical stimulation, does not require anesthesia, can be done at home, and often
feels good whether you ejaculate or not. In addition, studies at the Miami Project
demonstrate better sperm quality in samples obtained by vibratory stimulation.
Although many clinics still use only electrical stimulation because it is more
dependable, the American Urological Association recommends vibratory stimulation
as the first line of treatment for people with SCI.
Once a sample is obtained, sperm quality SHOULD BE assessed for several factors:
sperm count, motility, morphology, viscosity, volume and ability to penetrate
mucus. An average sperm count is about 100 million per milliliter. Motility
represents the percentage of sperm that are moving, and at least 50 percent
³swimmers² is considered normal. Morphology refers to the shape of the sperm.
Typically only 50 percent to 80 percent are normal, but malformations do not cause
malformations in the fetus. Viscosity is the thickness of the semen. Volume, as
opposed to sperm count, measures the total amount of ejaculate and may vary
from 1 to 5 milliliters, or about a teaspoon. Then a penetration test is done to
determine whether the sperm, once it gets to the ovum, will be able to bore
through the cell lining to deliver its genetic message.
Men with SCI generally have adequate volume and sperm count. If thereıs a
problem, itıs usually caused by low motility. But even if your spermıs motility is too
low for home intravaginal insemination, it can still be used in combination with
other assisted reproductive technology (ART) to improve chances of conception.
ARTs are ways to deliver sperm to the ovum. [See TK TK New Mobility]
Although low motility does not seem to be caused by lifestyle factors such as sitting
in a wheelchair or bladder management, healthy habits canıt hurt. Avoid smoking,
excess alcohol and caffeine, runaway stress, toxic chemicals and excessive heat to
the scrotum from baths or hot tubs. Even in men without SCI, caffeine and
smoking have been shown to decrease sperm motility and the number of dead
sperm. With already low motility, we canıt afford unnecessary compromise.
Cheryl read ABOUT SUPPLEMENTS TO IMPROVE SPERM QUALITY AND put me on a
regimen of L-arginine, zinc and multi-vitamins, including the antioxidant vitamins A
and C. I have no proof that these supplements were a factor in our eventual
success, but they did make us feel we were doing all we could to help.
Preparation
If you want to try vibratory stimulation with at-home intravaginal insemination, be
aware that many infertile couples who have pursued biological parenthood have
described the process as an emotional roller coaster. Assess the strength of your
relationship and your other priorities in life before you decide you are prepared for
the stress this process can create. Be open and honest with yourselves.
Itıs also important to understand the odds for conception. According to the authors
of New Options for Fertility, a couple without any fertility problems who have
intercourse at about the time of ovulation have almost a 25 percent chance that
pregnancy will result. The cumulative conception rate over a year is about 80
percent.
But when you factor in decreased sperm quality and the comparative unreliability of
collecting ejaculate using a home vibrator, it becomes apparent that this process
can easily take two years. In my case, I managed to ejaculate at the appropriate
time only five times over an 18 month period. Other men with SCI have reported
similarly erratic success. Unfortunately, I do not have a solution, although greater
success is reported with a rested body and empty bowels. If you need more
predictability, I recommend finding a clinic that combines electrical stimulation with
ART.
FOR SAFETY, you might want to try your first vibrostimulation at a center or clinic
where your blood pressure can be monitored. Another advantage is that if you
donıt ejaculate outwardly, you can be catheterized to determine if you had a
retrograde ejaculation in which the semen goes into the bladder.
The reproductive health of the female partner should also be monitored. She should
let her physician know she is planning to get pregnant, and begin charting her
menstrual cycles to help pinpoint the day of ovulation. Cheryl and I invested in an
ovulation predictor kit--about $48 for 6 tests, available at most pharmacies--to
eliminate some of the guessing.
We decided to try at-home insemination for two years. This decision was based on
my sperm analysis, Cherylıs age, and our general state of readiness to add a child
to our family. We were also open to adoption, and had just started exploring it as
an option when Jeremy was conceived.
Realistic expectations, an understanding of other fertility options and a discussion
of your reactions if thereıs no pregnancy are all helpful in reducing the potential
for stress. The contribution of stress as a factor in infertility is beginning to gain
serious attention--there are many accounts of people who conceive only after they
give up all hope and stop trying so hard.
Technique
Equipped with knowledge of your sperm quality and your partnerıs ovulation
status--and a prescription for autonomic dysreflexia if you need it--you can begin
the process. You need a vibrator, a specimen cup and a 10 cc syringe with a plastic
plunger (the black latex used on some plungers kills sperm) without a needle. You
may have to experiment with over-the-counter vibrators before you find one that
works for you. I use the Panasonic Panabrator IX that has a foot-long handle, a
4-inch head and a rheostat for changing speeds. You can buy something similar at
stores like Service Merchandise, Sharper Image or Brookstone for around $40.
Over-the-counter vibrators are low-amplitude, and effective for about 30 percent
to 40 percent of all men with SCI. High-amplitude models work FOR OVER 70
PERCENT OF MEN WITH SCI, but theyıre not widely available. The Ferti Care, is
currently distributed in US by ILTS. The price of the home version is about $365.
Try stimulating the shaft of the penis for about a minute, then focusing in on the
underside next to the head of the penis for another minute. It is very important to
use the vibrator for only a couple of minutes at a time, with at least a couple of
minutes off, to avoid skin breakdown and excessive swelling. In the interval, you or
your partner can continue to stimulate your penis. Massaging the perineum, THE
AREA BELOW YOUR SCROTUM, while you are being stimulated with the vibrator
may also help.
It is normal for the stimulation to cause increased muscle tension in your abdomen,
hands and other parts of the body. Itıs a part of the sexual response cycle. With
SCI this muscle tension may be exaggerated, and the stimulation should be stopped
if it becomes too intense. But for many, this tension helps build sexual excitement.
The release of this tension through spasm in the legs, shaking in the entire body or
ejaculation is sometimes experienced as an orgasm. Donıt be shocked if your
ejaculate looks rusty--this seems to be a normal variation in almost 20 percent of
men with SCI.
If you cannot feel the vibrator, increased muscle tension in your pelvic area may be
a sign you are close to ejaculation. You or your partner should be prepared to catch
the ejaculate in the cup and draw it up into the syringe. Your partner can then lie
on her back with her knees drawn up, and insert the syringe into her vagina as she
would a tampon. Avoid artificial lubricants such as baby oil or KY, because they kill
sperm. After she removes the syringe, it may help for her to remain in the same
position for another 15 or 20 minutes. From then on, hope for the best.
Although the process described is quite clinical, it can also be great fun. Cheryl and
I usually lit candles and played music to help set a relaxed atmosphere. We only
tried to get an ejaculate for about ONE-HALF hour, and we made sure we were
both sexually satisfied whether I ejaculated or not. On the day Jeremy was
conceived, Cheryl was massaging my feet when I ejaculated. When she injected the
sperm into her vagina, the CD player shifted from Sade to the Rolling Stonesı "Love
is Strong." Mick Jagger and I serenaded Cheryl and cheered my sperm along.
For additional information, contact the Male Fertility Research Program, The Miami
Project to Cure Paralysis, University of Miami, 1600 N.W. 10th Avenue, R-48,
Miami, FL 33136
305-243-6226
nbracket@miamiproj.med.miami.edu
New Options for Fertility, pub info please >>
Wisot, A. L., & Meldrum, D. R. (1990). New Options for Fertility: A Guide to In
Vitro Fertilization and other Assisted Reproductive Methods. New York: Pharos.
From Tepper, M. S. (1997, September). Making babies: vibrostimulation and
insemination. New Mobility, 8, 18, 20, 22. This article appears in the following topics:
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