Spina bifida 5 – fertility

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This series is covering all you need to know about spina bifida. In the previous posts we looked at issues around diagnosis and antenatal counselling. In this post, we look at fertility problems associated with spina bifida.

Folate is essential for rapidly dividing cells, and problems with folate metabolism can lead to miscarriage. Spina bifida risk is not increased for women who have families in later life.

What issues do people with spina bifida face before pregnancy?

Precocious puberty is an issue in some patients with hydrocephalus. Intrauterine factors control timing of puberty and early shunting does not influence the outcome.

Early puberty in the context of disability and immaturity can be a burden. Treatment with GRH agonists can put puberty “on hold” but is expensive.

What fertility issues do girls with spina bifida face?

Girls with spina bifida are usually fertile. Because of early puberty they may be fertile early and could be subject to exploitation – their maturity and executive functioning deficits contribute. Regular contraceptive precautions should be advised.

Women with spina bifida need to understand the risk of neural tube defects in babies. They should use folate supplementation prior to conception. Antenatal ultrasound can be an aid to early detection.

Couples should consider what would they do as parents if their baby is found to have a neural tube defect.

And what issues do boys with spina bifida face?

Because the spinal cord co-ordinates erection and ejaculation, sexual function is often reduced in males with spina bifida. Recurrent UTI’s can reduce fertility as can retrograde ejaculation.

However, some patients will be fertile even if they are incontinent.

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Lydia Garside is a general paediatrician based at Sydney Children’s Hospital

Author: Lydia Garside

Lydia Garside is a general paediatrician based at Sydney Children’s Hospital