Fertility and Disabilities: 9 Things You Need to Know
Part 6, Podium & Parenthood: Fertility & family planning webinar series
Presented by Markham Fertility Centre in partnership with Canadian Sport Institute Ontario (CSIO).
Navigating fertility challenges is complex for anyone, but for individuals living with disabilities, the journey can come with unique considerations, additional barriers, and often overlooked possibilities. Thanks to advances in medicine, technology, and a growing awareness of inclusive reproductive care, many people with disabilities are building families in ways that were once unimaginable.
Let’s explore the topic of fertility and disabilities, including the different types of disabilities, fertility basics, challenges, available treatments, and key considerations for pregnancy and family building. Whether you are living with a disability or supporting someone who is, this resource is designed to inform, empower, and guide you through the family-building journey.
We will cover:
- Fertility and disabilities
- Medical factors that may affect individuals with a disabilities
- How disabilities affect fertility
- Barriers to embryo creation and conception
- Fertility treatment options for people with disabilities
- How disabilities may affect pregnancy
- Genetic considerations and preimplantation genetic testing (PGT)
- Fertility preservation for progressive disabilities
- The importance of preconception planning
See Part 1, Podium & Parenthood: Fertility 101
See Part 2, Podium & Parenthood: Fertility Preservation
See Part 3, Podium & Parenthood: Understanding the Menstrual Cycle
See Part 5, Podium & Parenthood: Infertility Treatments – Timed intercourse, IUI & IVF
1. Fertility and Disabilities
What is Disability?
In Canada, disability is defined under the Accessible Canada Act (2019) as any impairment, whether physical, mental, intellectual, sensory, or episodic, that affects an individual’s full participation in society. Disabilities can be:
- Physical (e.g., spinal cord injuries, cerebral palsy, multiple sclerosis)
- Sensory (e.g., vision loss, hearing impairment)
- Developmental or Cognitive (e.g., autism spectrum disorder, intellectual disability)
- Mental Health-Related (e.g., depression, anxiety)
- Chronic Illness-Related (e.g., arthritis, diabetes, autoimmune diseases)
It is essential to recognize that disability is not a one-size-fits-all category. The experiences, capabilities, and health needs of individuals with disabilities vary greatly. Importantly, disability does not automatically equate to infertility.
What is Fertility?
Fertility refers to the natural capacity to conceive and carry a pregnancy to term. The Society of Obstetricians and Gynaecologists of Canada (SOGC) defines infertility as the inability to achieve pregnancy after 12 months of regular unprotected intercourse or after six months if the individual is over 35 years of age.
Key Terms Defined:
- Hypothalamus: A region of the brain that produces hormones regulating many bodily functions, including reproduction.
- Pituitary Gland: An organ that produces hormones like Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) essential for ovulation and sperm production.
- Ovaries: The reproductive organs in females that store eggs and produce hormones such as estrogen and progesterone.
- Testes: Male reproductive organs responsible for producing sperm and testosterone.
- Fallopian Tubes: Tubes that carry eggs from the ovaries to the uterus and where fertilization occurs.
- Uterus: The organ where a fertilized egg implants and a pregnancy grows.
Before exploring how disabilities may impact fertility, it’s helpful to understand the basics of natural fertility. The reproductive system is orchestrated by a complex interplay of hormones and organs. The hypothalamus, located in the brain, signals the pituitary gland to release key reproductive hormones, including Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). In individuals with ovaries, these hormones stimulate the growth and maturation of eggs in the ovaries. The dominant egg is released during ovulation and, if fertilized by sperm, can implant in the uterus and grow into a pregnancy. In individuals with testes, these hormones stimulate the production of sperm, a process that occurs continuously throughout life.
Unlike sperm, which is produced continuously, individuals assigned female at birth are born with a finite number of eggs. This means that female fertility is time-sensitive and gradually declines with age. Males typically have a longer reproductive lifespan since sperm is generated regularly. Understanding this biological difference is crucial in considering fertility preservation and treatment options for individuals with disabilities.
2. Medical Factors That May Affect Fertility in Individuals with Disabilities
Disability and Its Impact on Reproductive Health
Disabilities can take various forms and may affect fertility in different ways. Muscle power impairments, such as those seen in spinal cord injuries, muscular dystrophy, or spina bifida, can affect mobility and sexual function. Some individuals experience impaired range of movement or joint contractures, which can limit physical ability to engage in intercourse. Limb deficiencies—whether from trauma, illness, or congenital causes—may also pose unique reproductive challenges.
Certain genetic conditions such as achondroplasia or Turner Syndrome can affect stature and reproductive function. Achondroplasia, for example, is a form of dwarfism that can be inherited, while Turner Syndrome often leads to premature ovarian insufficiency. Intellectual impairments may influence reproductive decision-making, communication, and consent, requiring careful, individualized care. While many people with disabilities have no direct fertility issues, some medical conditions or treatments may affect fertility:
- Neurological conditions like multiple sclerosis (MS) or spinal cord injury (SCI) can impact sexual function, hormonal regulation, or mobility necessary for intercourse or carrying a pregnancy.
- Autoimmune diseases such as lupus or rheumatoid arthritis can affect fertility directly or through medications that are harmful to reproductive health.
- Medications such as chemotherapy, antiepileptics, or psychiatric drugs may impair fertility or increase the risk of birth defects.
- Mobility limitations can create physical barriers to sexual activity or pregnancy management.
Muscle Power Impairments
- Includes conditions like spinal cord injuries, muscular dystrophy, and spina bifida.
- These conditions can impact mobility, sexual function, and reproductive processes.
Impaired Range of Movement
- Characterized by increased muscle tone, contractures, or immobilization.
- Can make sexual activity and medical examinations more difficult.
Limb Deficiency
- May result from trauma, illness, or congenital factors.
- Physical challenges may require adaptive reproductive care strategies.
Stature-Related Genetic Conditions
Examples include:
- Achondroplasia: A form of dwarfism with autosomal dominant inheritance.
- Turner Syndrome: A chromosomal disorder affecting females, often leading to infertility due to premature ovarian insufficiency.
Intellectual Impairments
- Includes a broad spectrum of cognitive disabilities that may influence decision-making, access to care, and consent in reproductive health.
Source: Government of Canada: Disability in Canada
However, many individuals with disabilities do not face biological infertility but rather logistical, social, or systemic barriers to conception and pregnancy.
3. How Disabilities Affect Fertility
Reproductive challenges in people with disabilities often fall into three main categories: the production of eggs or sperm, the meeting of these gametes for fertilization, and the implantation and maintenance of a pregnancy.
Disruption in the brain’s hormonal signaling due to conditions like traumatic brain injury or cerebral palsy can prevent the ovaries or testes from producing viable gametes. Additionally, the gonads themselves may fail to respond to signals, as seen in cases of premature ovarian insufficiency or after cancer treatments such as chemotherapy.
In these situations, hormonal treatments using injectable forms of FSH, LH, and HCG can stimulate the ovaries or testes, provided that functional gametes remain. If not, egg or sperm donation becomes necessary to achieve pregnancy. Fertility in individuals with disabilities can be influenced by:
- Production of gametes (eggs and sperm)
- Transport and meeting of gametes
- Implantation and pregnancy
Disruption in Hormonal Signaling
In some cases, the hypothalamus or pituitary gland may not produce adequate signals (FSH, LH), preventing egg maturation or sperm production. Causes can include:
- Traumatic brain injuries
- Cerebral palsy
- Medication-induced hormonal suppression
Alternatively, the ovaries or testes may fail to respond to signals due to:
- Premature ovarian insufficiency (e.g., Turner Syndrome)
- Gonadal failure following chemotherapy or radiation
- Natural menopause
Treatment Options:
- Hormonal therapy (FSH, LH, HCG) for stimulation
- Egg or sperm donation if ovarian or testicular failure is present
Sources:
4. Barriers to Embryo Creation and Conception
Physical barriers can also play a significant role. Erectile dysfunction and ejaculatory disorders are common in individuals with spinal cord injuries. Physical limitations, pain, or mobility issues may make intercourse challenging or impossible. Medications such as muscle relaxants and antidepressants can further impact sexual function.
Psychological barriers should not be overlooked. The emotional burden of infertility and the added complexity of living with a disability can create significant mental health challenges. Support from specialized counsellors and peer groups can be invaluable.
Physical and Functional Barriers:
- Erectile Dysfunction: Common in spinal cord injuries
- Ejaculatory Disorders: May prevent sperm release
- Mobility Impairments: Affect positioning and ability to engage in intercourse
- Pain and Discomfort: Due to contractures or pelvic abnormalities
- Medication Side Effects: Impact libido and function (e.g., muscle relaxants, antidepressants)
Emotional and Psychological Impact:
- Fertility journeys can be emotionally taxing, especially when combined with the complexities of living with a disability.
- Learn about counselling and support with Markham Fertility Centre
5. Fertility Treatment Options for People with Disabilities
Several fertility treatments are available, each offering hope and possibilities. Timed intercourse involves tracking ovulation through hormone tests, ultrasound, or basal body temperature to optimize the timing of intercourse. This approach can reduce stress and improve efficiency.
1. Timed Intercourse
- Ovulation tracking via:
- Urine LH kits: Detect the luteinizing hormone (LH) surge.
- Ultrasound monitoring: Tracks ovarian follicle growth.
- Basal body temperature: Tracks ovulation via temperature changes.
- Can minimize frequency of intercourse while maximizing conception chances.
2. Intrauterine Insemination (IUI)
- In IUI, sperm is inserted directly into the uterus to increase the chances of fertilization. This treatment is:
- Suitable for individuals using donor sperm or those unable to have penetrative intercourse.
- Less invasive and more accessible with proper physical accommodations.
- Learn more about the intrauterine insemination (IUI) procedure.
3. In Vitro Fertilization (IVF)
IVF involves retrieving eggs, fertilizing them in a lab, and transferring embryos into the uterus.
IVF Key Steps:
- Ovarian Stimulation: Hormones stimulate multiple eggs.
- Egg Retrieval: Eggs are collected via ultrasound-guided aspiration.
- Fertilization: Embryos are created.
- Embryo Transfer: Embryos are implanted into the uterus.
Wheelchair accessibility and tailored sedation are crucial for equitable IVF access. Learn more about the in vitro fertilization procedure.
IVF Fertilization Methods:
- Conventional IVF: Sperm meets egg in the lab dish.
- Intracytoplasmic Sperm Injection (ICSI): Single sperm is injected directly into the egg—often necessary for low sperm count or motility.
4. Sperm Retrieval Techniques:
When ejaculation is not possible, surgical sperm retrieval techniques can help. Testicular Sperm Aspiration (TESA) or Percutaneous Epididymal Sperm Aspiration (PESA) can obtain sperm directly from the testes or epididymis. Electroejaculation is another option, using a rectal probe to stimulate ejaculation in individuals with spinal cord injuries.
- TESA (Testicular Sperm Aspiration)
- PESA (Percutaneous Epididymal Sperm Aspiration)
- Used in cases of spinal cord injury or azoospermia.
5. Electroejaculation:
- A technique using a rectal probe to trigger ejaculation when nerve pathways are impaired.
Source: Markham Fertility Center link pg.
6. Third Party Reproduction
Third-party reproduction refers to using someone else’s reproductive material or assistance to build a family. This can include:
- Sperm donation: Used when the intended parent cannot produce viable sperm. Donor sperm can be used with IUI or IVF.
- Egg donation: When another individual provides eggs for fertilization, typically used when the intended parent cannot produce viable eggs.
- Embryo donation: Embryo donation involves the transfer of surplus embryos from individuals or couples who have completed their own fertility treatment to another individual or couple wishing to achieve pregnancy. These embryos, originally created through IVF, can offer a path to parenthood for those unable to use their own eggs or sperm. Embryo donation may be anonymous (to a certain extent) or known, and it is often considered by individuals facing infertility, genetic conditions, or recurrent pregnancy loss.
- Gestational surrogacy: A gestational carrier (surrogate) carries and gives birth to a child conceived using the intended parents’ or donors’ gametes. The surrogate has no genetic link to the baby.
Legal, ethical, and emotional considerations are vital in third-party reproduction, and expert guidance from fertility clinics, counselors, and legal professionals is essential. In Canada, altruistic surrogacy is legal, meaning surrogates can only be reimbursed for expenses (AHRA, 2004). Legal and ethical considerations vary by jurisdiction, and it is essential to consult with legal counsel and fertility specialists.
Source: CFAS Third Party Reproduction Guidelines
6. Fertility and Disabilities: How Disabilities may affect Pregnancy
Pregnancy can place additional strain on individuals with physical or intellectual impairments. Pregnancy in individuals with disabilities may carry higher risks. Physical impairments can be exacerbated by the weight and postural changes of pregnancy. There is also a higher risk of preterm birth, gestational diabetes, blood clots, urinary tract infections, and delivery complications.
A unique concern for those with spinal cord injuries is autonomic dysreflexia, a potentially life-threatening condition where the nervous system overreacts to stimuli such as labor, bladder issues, or constipation.
Key Risks:
- Preterm Birth: Spontaneous or medically indicated early delivery
- Gestational Diabetes: Increased risk particularly in individuals with mobility limitations
- Venous Thromboembolism (VTE): Blood clots are more common due to reduced mobility
- Pressure Sores: Weight gain in pregnancy can exacerbate risk
Spinal Cord Injury-Specific Risk:
- Autonomic Dysreflexia: A life-threatening overreaction of the autonomic nervous system to triggers like labor, bladder distension, or infection.
Source: Government of Canada: Maternal Health
7. Genetic Considerations and Preimplantation Genetic Testing (PGT)
Some disabilities, such as achondroplasia, have a known genetic inheritance pattern. Couples may opt for Preimplantation Genetic Testing (PGT) during IVF to avoid transmission of the condition.
PGT Process:
- IVF embryos are grown to the blastocyst stage.
- A few cells are biopsied from each embryo.
- Genetic analysis is performed to detect mutations.
- Only unaffected embryos are transferred.
For individuals with heritable genetic conditions, prenatal diagnosis offers options for early detection. Learn more about preimplantation genetic testing (PGT). Two common methods are:
- Amniocentesis: A procedure where a small amount of amniotic fluid is extracted for genetic testing.
- Chorionic Villus Sampling (CVS): Involves taking placental tissue for genetic analysis.
Both tests can identify genetic conditions early in pregnancy, allowing prospective parents to prepare or make informed decisions about continuing the pregnancy.
8. Fertility Preservation for Progressive Disabilities
For individuals with progressive conditions, early fertility preservation is highly recommended.
Methods Include:
- Egg Freezing (Oocyte Cryopreservation): A process where eggs are harvested, frozen, and stored for future use. This is particularly useful for individuals with ovaries facing medical treatments or progressive conditions.
- Sperm Freezing (Cryopreservation): Involves collecting and freezing sperm, which can be used later for insemination or IVF.
- Embryo Freezing (requires both egg and sperm): Fertilized eggs (embryos) are created and frozen for future use. This requires both sperm and eggs at the time of freezing and may limit future reproductive autonomy since both genetic contributors typically share ownership of the embryos.
Fertility preservation ensures future reproductive autonomy even as conditions evolve. Early fertility preservation allows individuals more choices later, especially in the context of progressive disabilities.
9. The Importance of Preconception Planning
Successful pregnancy outcomes for individuals with disabilities often hinge on careful preconception planning. This includes reviewing medications, managing pre-existing conditions, planning for the potential need for surgical deliveries, and preparing for postpartum care. Multidisciplinary teams involving fertility specialists, obstetricians, anaesthesiologists, genetic counsellors, and other allied health professionals can provide comprehensive care tailored to each individual’s needs.
Comprehensive preconception care involves:
- Medication review to ensure safety in pregnancy
- Consultation with specialists (OB-GYN, fertility, urology, anaesthesiology)
- Genetic counselling
- Birth planning and postpartum care considerations
This multidisciplinary team approach is essential to optimize outcomes for individuals with disabilities.
Fertility and Disabilities: Empowering Individuals with Disabilities to Build Families
Disabilities do not define one’s potential to become a parent. With advances in fertility medicine, compassionate care, and supportive resources, individuals with disabilities have more opportunities than ever to build the families they envision. Raising awareness, breaking down stigma, and fostering inclusion remain essential steps toward ensuring that everyone, regardless of ability, has access to reproductive health care and family-building options.
The journey to parenthood for individuals with disabilities may involve additional challenges, but with the right care, support, and medical advances, family-building is possible.
FAQs
1. Can people with disabilities have children?
Yes. Many people with disabilities can conceive naturally or with fertility treatments such as IVF, IUI, or assisted reproductive technologies. Medical support and individualized care can help address specific challenges.
2. Does having a disability affect fertility?
Not always. While some disabilities or medical conditions may affect reproductive health, many individuals with disabilities have normal fertility. In some cases, barriers are logistical or physical rather than biological.
3. What fertility treatments are available for people with disabilities?
Common fertility treatments include timed intercourse, intrauterine insemination (IUI), in vitro fertilization (IVF), sperm retrieval procedures, and third-party reproduction such as donor eggs, donor sperm, or surrogacy.
4. Can people with spinal cord injuries have children?
Yes. Individuals with spinal cord injuries may face challenges such as erectile dysfunction or ejaculatory disorders, but techniques like sperm retrieval, electroejaculation, and IVF can help achieve pregnancy.
5. What is preimplantation genetic testing (PGT)?
Preimplantation genetic testing (PGT) is a procedure performed during IVF to test embryos for specific genetic conditions before they are transferred to the uterus.
6. Are pregnancies riskier for individuals with disabilities?
Some disabilities may increase pregnancy risks such as preterm birth, blood clots, gestational diabetes, or delivery complications. Care from a multidisciplinary medical team helps manage these risks.
7. What is fertility preservation for progressive disabilities?
Fertility preservation involves freezing eggs, sperm, or embryos before a medical condition or treatment affects fertility, allowing individuals to have children in the future.
8. What is third-party reproduction?
Third-party reproduction involves using donor eggs, donor sperm, donated embryos, or a gestational surrogate to help individuals or couples build their families.
9. Why is preconception planning important for people with disabilities?
Preconception planning helps review medications, manage health conditions, assess genetic risks, and prepare for pregnancy with guidance from fertility specialists and healthcare providers.
10. Can people with genetic disabilities prevent passing conditions to their child?
In some cases, genetic conditions can be screened using preimplantation genetic testing (PGT) during IVF to help reduce the chance of passing inherited conditions to a child.
Fertility and Disabilities: Key takeaways:
- Disabilities do not define reproductive potential.
- Fertility treatments are available and adaptable.
- Inclusive, respectful care matters.
- Planning is key.
For more information and resources:
- Society of Obstetricians and Gynaecologists of Canada (SOGC): www.sogc.org
- Canadian Fertility and Andrology Society (CFAS): www.cfas.ca
- Government of Canada: Disability Resources: www.canada.ca