EDITOR: In the January 1997 issue of New Mobility, Mitch Tepper described the joy that his wife, Cheryl, and he shared in conceiving their son, Jeremy. Since their success was partly due to vibratory stimulation and at-home insemination, many readers have requested more information. The following article originally appeared in the September 1997 issue.

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 before ejaculation.  

Studies indicate that only about 10% 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 electro-ejaculation 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 mL. Motility represents the percentage of sperm that are moving, and at least 50% “swimmers” is considered normal. Morphology refers to the shape of the sperm. Typically, only 50-80% 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 mL, 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 there’s a problem, it’s usually caused by low motility. But even if your sperm’s 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 New Mobility, July/August 1995.]  

Although low motility does not seem to be caused by lifestyle factors such as sitting in a wheelchair or bladder management, healthy habits can’t 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 increase the number of dead sperm. With already low motility, we can’t afford unnecessary compromise. Cheryl read about supplements to improve sperm quality and put me on a regimen of L-arginine, zinc and multivitamins, 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 endeavor 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.  

It’s 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 don’t 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 $10-20 for multiple 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, Cheryl’s 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 there’s 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 partner’s 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) and 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 footlong handle, a 4-inch head and a rheostat for changing speeds. You can buy something similar online for around $20. 

Over-the-counter vibrators are low-amplitude, and effective for about 30-40% of all men with SCI. High-amplitude models work for more than 70% of men with SCI, but they’re not widely available. The FertiCare, currently distributed in Denmark, has FDA approval in the United States for investigative purposes, and is available only in a handful of research centers. The clinical model costs $4,000, the home version about $800.  

Try stimulating the shaft of the penis for about a minute, then focus 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. It’s a part of the sexual response cycle. With SCI this muscle tension may be exaggerated, and 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. Don’t be shocked if your ejaculate looks rusty — this seems to be a normal variation in almost 20% 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 15-20 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 tried to get an ejaculate for only about a 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 Stones’ “Love is Strong.” Mick Jagger and I serenaded Cheryl and cheered my sperm along. 

Other New Mobility stories on conceiving: 

Our In Vitro Fertilization Journey to Parenthood
The Great Sperm Hunt 
Double Trouble: The Embryo Transfer Gamble 
Knocked Up (So Many Ways to Grow a Family) 
The Male Fertility Research Program at The Miami Project to Cure Paralysis